Presentation
Post-partum headache. Rule out sinus thrombosis.
Patient Data
CTA demonstrates irregularity of the bilateral extracranial internal carotid and vertebral arteries consistent with dissections. Corresponding non-contrast CT demonstrates hyperdensity within the vessel walls confirming dissection. No large territorial infarct noted. No dural sinus thrombosis.
DWI and FLAIR demonstrate multiple small foci of hyperintensity within the bilateral cortical frontal lobes consistent with infarcts. Fat-saturated T1 demonstrates crescentic hyperintense signal within the walls of the extracranial internal carotid and vertebral arteries consistent with dissections.
Case Discussion
This case demonstrates bilateral extracranial cervical carotid and vertebral artery dissections in a early post-partum patient with headache. The DWI shows multiple foci of diffusion restriction consistent with infacrts from thromboemboli however the patient did not have any focal neurological deficits. The patient was treated with antiplatelet therapy and did not any have any further symptoms at follow-up.
Post-partum carotid and vertebral artery dissections are rare and represent ~6% of dissections in female patients <50 years old.1 Clinical presentation includes headache, neck pain, stroke, or Horner's syndrome and reported to occur 5-18 days following delivery.1 Recognition of this entity is important to guide appropriate diagnosis and management.
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