Bilateral internal carotid artery dissections related to pregnancy and childbirth.

ABSTRACT

We illustrate a 35 years old woman presenting with acute left hemiplegia three weeks after caesarean section. Cerebral MRI demonstrated acute right frontoparietal ischemic stroke, while angiographic investigations provided acute occlusion of the proximal right internal carotid artery due to a dissection and two additional dissections of the proximal and distal contralateral internal carotid artery. A skin biopsy revealed alterations like in some types of Ehlers-Danlos syndrome. Pregnancy, caesarean section, and possibly hormonal implicated connective tissue changes may have contributed to the dissections. Remarkably a second pregnancy with a close ultrasonographic vascular monitoring two years later succeeded upon caesarean section without complications, which gives an important input in the gestational guidance of risk patients.