Postpartum cerebral angiopathy treated with intra-arterial nicardipine and intravenous immunoglobulin.

Postpartum cerebral angiopathy (PCA) is a rare vasoconstriction syndrome that can lead to severe disability and death. The pathophysiology of PCA is unknown. A case of a 39-year-old woman who developed PCA 3 days after twin delivery is reported. She presented with right hemiparesis, aphasia and lethargy. Imaging studies demonstrated severe segmental narrowing of multiple cerebral arteries comprising the anterior and posterior circulations. She continued to deteriorate despite induced hypertension, immunosuppression, intravenous magnesium and oral nimodipine. Intra-arterial administration of nicardipine on three consecutive occasions reversed the angiographic vasospasm and led to symptom resolution. Definite improvement occurred after a 5 day course of intravenous immunoglobulin (IVIg). The patient described in this report developed recalcitrant PCA-induced vasospasm which resolved with endovascular administration of nicardipine and immunotherapy with IVIg.

Endovascular treatment of severe vasospasm in nonaneurysmal perimesencephalic subarachnoid hemorrhage.

BACKGROUND: Nonaneurysmal perimesencephalic subarachnoid hemorrhage (SAH) has usually a benign prognosis and uneventful course; however, recent reports suggest that these patients may develop severe symptomatic vasospasm. METHODS: Description of the clinical course of one patient with nonaneurysmal perimesencephalic SAH who required intraarterial infusion of calcium antagonists and transluminal balloon angioplasty for treatment of symptomatic vasospasm. The perimesencephalic clot burden was quantified to determine if there is a relationship with the development of symptomatic vasospasm. RESULTS: Despite maximized clinical management, the patient described in this report developed vasospasm and delayed cerebral ischemia (DCI), requiring multiple endovascular interventions. The volumetric quantification of subarachnoid blood was 15.4 ml, and was mostly localized in the cisternal space. CONCLUSIONS: Nonaneurysmal perimesencephalic SAH may have a "malignant" course requiring close neurocritical care monitoring and multiple clinical and endovascular interventions. Moreover, large cisternal hemorrhage was correlated with the development of DCI in this patient with non-aneurysmal SAH.

Prevalence of stroke in Restless Legs Syndrome: Initial Results Point to the Need for More Sophisticated Studies.

BACKGROUND: Recent studies suggest a potential relationship between Restless Legs Syndrome (RLS) and hypertension and heart disease. Acute clinical stroke has been linked to the immediate onset of RLS, and epidemiological studies suggest the possibility that RLS may also lead to stroke. METHODS: MRI scans from 26 RLS cases and 241 controls from the population based MEMO-Study (Memory and Morbidity in Augsburg Elderly) were assessed for the presence of clinical stroke, silent infarction, subcortical lesions and cortical atrophy. T1, T2, proton density images were obtained and infarcts and their characteristics were determined by visual inspection. RLS status was assessed according to the minimal criteria of the International RLS Study Group. Scans from the 26 RLS patients and a subset of 26 age and sex matched controls were reexamined by a separate rater using the same methodology. Descriptive statistics, logistic and linear regression models were used to determine the risk of the three types of CNS changes associated with RLS case status. RESULTS: Among the 267 participants there was no difference in the prevalence of cardiovascular diseases or risk factors between RLS patients and the 241 controls. The prevalences of cerebrovascular events of all types, were greater in RLS patients, as were the amounts of cortical atrophy and the volume of subcortical lesions. However, these differences were not statistically significant. When age, sex and co-morbidities were taken into account in a logistic regression model, there was a statistically non-significant greater risk for stroke (Odds Ratio 2.46 with 95% CI 0.97-6.28, p = .06) associated with RLS case status. CONCLUSIONS: Future similar studies need to be performed on younger patients without other potential vascular risk factors, using Flair images and computerized programs for detection of cerebral ischemia. Improved methods for detection may allow for a reasonable sample size.