Postpartum vertebral artery dissection: case report and review of the literature

Abstract

Background Hypertensive 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 presentation A 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. Conclusion 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. 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.

Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

“…Women older than 35 years and those with a history of HDP or autoimmune disease (that is, systemic lupus erythematosus, anti-phospholipid syndrome) are particularly at high risk. Other predisposing factors of arterial dissection in the peripartum period include intimal injury related to Valsalva maneuvers during labor, alterations in arterial wall integrity due to pregnancy-related hormonal or vasoactive substances [ 9 ], and reactive thrombocytosis (subsequent to postpartum hemorrhage), which may all play potential roles in this process and require further investigation [ 16 ]. Moreover, prompt diagnosis and management of VAD are essential to ensure favorable patient outcomes.…”

Postpartum Acute Basilar Artery Occlusion Secondary to Vertebral Artery Dissection. Case Report and Literature Review

“…A proposed hypothesis is dissection in the presence of an underlying structural defect of the arterial wall in the context of a connective tissue disorder, but most of the young women included in studies were not reported to present with such diseases. There is, however, evidence to support that the physiological changes that occur during pregnancy might contribute to artery dissection: that is, hemodynamic forces are intensified by increased blood volume and cardiac output, which can cause additional stress to the vessel walls, hormone-mediated changes concerning vasoactive substances, and collagen degradation [ 13 , 22 , 23 , 24 , 25 ]. A report by Salehi Omran et al (2020) offered results of an investigation into this area, which proved that pregnancy is an independent risk factor for CAD.…”

Clinical Characteristics, Course, and Outcomes of Vertebral Artery Dissections in the Postpartum Period

“…[18][19][20] Prior literature on ppVADs has been limited by small sample sizes in case reports, making it difficult to compare ppVADs accurately with nonpostpartum VADs. 3,4,7,8,[11][12][13]16,17 We present the largest cohort of patients with postpartum VADs to date.…”

“…1 VADs occur in the postpartum period, but the majority of the literature on postpartum vertebral artery dissections (ppVADs) is in the form of case reports. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The largest cohort of VAD patients from a single institution consisted of 5 women with 6 VADs (1 being bilateral). 16 Despite accounting for only 2.4% of all spontaneous VADs, 4 ppVADs are devastating and have been documented to result in several deaths of otherwise healthy women.…”