Dynamic nature of postpartal carotid artery dissection

Abstract

Craniocervical carotid artery dissection (CCAD) is an important cause of stroke in young adults, but it has rarely been reported as a cause of stroke in puerperium. We report the case of a 27-year-old female with a history of migraine who presented with unilateral left headache, transient episodes of dysphasia and right hemiparesis 30 days after vaginal delivery. The first symptoms started six days after the prolonged childbirth. The first magnetic resonance angiography revealed dissection in the supraclinoid and a cavernous segment of the left Internal carotid artery (ICA). We followed up the patient for two years and she had an unstable course. During this time, she had occlusion of the supraclinoid segment of the left ICA, with caudal extension on the extracranial segment and recanalisation one month later. Two months later, she had intracranial extension with dissection of the left anterior cerebral artery. During this time, she suffered from two strokes with minimal neurological impairment and good clinical recovery. The pathophysiology of CCAD appears to be multifactorial. Vessel wall injury related to the Valsalva manoeuvre during labour, as well as hemodynamic and hormonal changes of the vessel wall related to pregnancy in a patient with a history of migraine, may be causes of postpartum spontaneous craniocervical artery dissection in healthy women.