<abstract xmlns="http://www.w3.org/1999/xhtml"> 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.</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.

Dynamic Nature of Postpartal Carotid Artery Dissection

Special Hospital for Cerebrovascular Diseases „Sveti Sava“, Stroke Unit, Belgrade, Serbia

Special Hospital for Cerebrovascular Diseases „Sveti Sava“, Department of Radiology, Belgrade, Serbia

Special Hospital for Cerebrovascular Diseases „Sveti Sava“, Department of Interventional Radiology, Belgrade, Serbia

Experimental and Applied Biomedical Research (EABR)

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"Dynamic Nature of Postpartal Carotid Artery Dissection"}

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...

Dynamic Nature of Postpartal Carotid Artery Dissection

Published Online: Jun 10, 2016

Page range: 167 - 174

Received: Apr 23, 2015

Accepted: Nov 24, 2015

DOI: https://doi.org/10.1515/sjecr-2016-0015

Keywords
CCAD, stroke, migraine, pregnancy, postpartum, collateral circulation, MRI, DSA

© 2016

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Dynamic Nature of Postpartal Carotid Artery Dissection

Published Online: Jun 10, 2016

Page range: 167 - 174

Received: Apr 23, 2015

Accepted: Nov 24, 2015

DOI: https://doi.org/10.1515/sjecr-2016-0015

KeywordsCCAD, stroke, migraine, pregnancy, postpartum, collateral circulation, MRI, DSA

© 2016

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
CCAD, stroke, migraine, pregnancy, postpartum, collateral circulation, MRI, DSA