MRI Features of Neurological Complications During the Postpartum Period: Think beyond CVT and PRES

Abstract

Background: The assessment of the individual magnetic resonance imaging (MRI) features provides vital clues about the diagnosis of neurological complications during the postpartum period assists in the determination of the common neurological complications, differentiates these neurological disorders on basis of the MRI features, and helps with the early treatment planning. This study aimed to describe various complications that occur during the postpartum period to describe the MRI features of these neurological complications and the differentiating features from each other. Materials and Methods: The study was a retrospective hospital-based analysis study conducted in the Department of Radiodiagnosis and modern imaging, Maharana Bhopal government hospital and RNT Medical College Udaipur, Rajasthan, India, from October 2017 to September 2018 (All the patients presented during this time frame were included in the study). A total of 58 postpartum cases of neurological disorders who were referred to the department for radiological evaluation and who had positive MRI imaging findings were included in the study. Results: Most common neurological symptoms were seizures followed by headache and focal neurological deficit (FND). Moreover, the most typical neurological complication was cerebral vein thrombosis, followed by posterior reversible encephalopathy syndrome (PRES). Other common complications were intracranial hemorrhage, ischemic infarcts, infections, acute hypoxic-ischemic encephalopathy, and metabolic encephalopathy. Rare but important findings included postpartum hypernatremic encephalopathy with extra pontine myelinolysis and rhabdomyolysis and postpartum reversible cerebral vasoconstriction syndrome (PRCVS). Conclusion: MRI, along with angiography and venography, is the modality of choice to evaluate postpartum neurological symptoms and plays a crucial role in the early diagnosis of neurological complications. Furthermore, MRI helps establish this diagnosis early to avoid further complications.