Dados do Trabalho

Título

Internal Carotid Artery Dissection in the Postpartum Period

RESUMO

Case presentation
Caso 1 – A 36 year-old woman, on the 21st day after vaginal delivery, presenting a sudden episode of complete left hemiplegia, hemi-hypoesthesia and tactile and auditory hemineglect. She had moderate-intensity right hemicranial headache started 12 hours before the event. She was admitted to the emergency department 1 hour and 17 minutes after the ictus (NIHSS 11), undergoing a CT scan of the skull with ASPECT 10 and then submitted to venous thrombolysis, with no neurological improvement. Subsequently, she performed a new cranial CT showing right frontoparietotemporal hypodensity and extracranial CT angiography showing signs of dissection of the right internal carotid artery and irregular proximal third on the left internal carotid artery, with focal ectasia. Case 2 – A 33-year-old woman, on the 14th day after cesarean delivery, had a sudden episode of complete left hemiplegia, hemi-hypoesthesia and hemineglect for all modalities. She had a mild headache with progressive onset. She was admitted to the emergency department with 5 hours after the ictus (NIHSS 8), with CT of the head was normal. Under investigation, she performed a new head CT 48 hours after the event, with right frontoparietotemporal hypoattenuation and extracranial CT angiography with signs of bilateral internal carotid artery dissection.
Discussion
Cervicocerebral arterial dissection is one of the most frequent causes of ischaemic stroke in young and middle-aged adults. (1) However, postpartum cervicocerebral arterial dissections are much rarer, accounting for only 6% of spontaneous arterial dissection in women under the age of 50. Headache and neck pain are the most common symptoms in postpartum cervical carotid and vertebral artery dissections, accounting for 60% to 90% of cases. (2) The pathophysiology of cervical artery dissection appears multifactorial, with evidence suggesting environmental and genetic contributions. (3)
Final Coments
We describe two cases of ischaemic stroke secondary to carotid artery dissection in the puerperium. Therefore, severe headache and neck pain during this period should be rigorously evaluated in view of the possibility of a poor prognosis mainly related to misdiagnosis and delay in treatment.