Abstract
BackgroundHypertensive disorders of pregnancy are associated with vascular complications, including ischemic stroke and cervical artery dissection. Vertebral artery dissection (VAD), however, is rare. We describe a 31-year-old female who presented with vertigo, nausea, and vomiting and was found to have a VAD. In addition, we discuss the presentation, differential diagnosis, and pathogenesis of this uncommon but clinically significant vascular event and summarize other cases of vertebral artery dissection described in the medical literature.Case presentationA 31-year-old Hispanic woman presented 10 days postpartum with a one-day history of vertigo, nausea, vomiting, and frontal headache. The patient’s pregnancy course had been complicated by preeclampsia, chorioamnionitis, and iron-deficiency anemia, and her delivery was complicated by acute hemorrhage. Physical examination was significant for left leg ataxia. Laboratory studies showed marked thrombocytosis. Emergent computed tomography (CT) scan of the head was obtained and revealed a left cerebellar ischemic large vessel stroke. Subsequent CT angiography of the head and neck showed a left VAD. Based on correlation of the clinical history and laboratory and imaging findings, a diagnosis of vertebral artery dissection secondary to reactive (secondary) thrombocytosis from overlapping iron-deficiency anemia and acute hemorrhage was established. The patient was started on a heparin infusion and experienced significant improvement after a four-day hospitalization.ConclusionVAD is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women aged 30 years or older and those with a history of a hypertensive disorder of pregnancy are at particularly high risk. Prompt diagnosis and management of VAD is essential to ensure favorable outcomes.
Highlights
Hypertensive disorders of pregnancy (HDP) are associated with vascular events, including stroke (Liffert et al) and cervical artery dissection [1]
Vertebral artery dissection (VAD) is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo
Our case is unique because our patient presented with an isolated left vertebral artery dissection in the setting of reactive thrombocytosis secondary to acute hemorrhage from delivery and subacute blood loss from persistent vaginal bleeding, both of which were superimposed on iron-deficiency anemia from pregnancy
Summary
We present the case of a 31-year-old woman who presented 10 days postpartum with a posterior cerebellar stroke secondary to VAD, and we summarized known cases of isolated VAD in pregnancy in the literature. To our knowledge, this is the first report of isolated postpartum VAD with reactive thrombocytosis secondary to overlapping iron-deficiency anemia and acute hemorrhage. VAD is a rare cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with nonspecific symptoms such as headache and/or vertigo. Prompt diagnosis and management of VAD is essential to ensure favorable patient outcomes
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call