Intracerebral hemorrhage as a complication of reversible cerebral vasoconstriction syndrome in the postpartum periods: a case report

Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular condition marked by the diffuse, reversible narrowing of multiple segments of cerebral arteries. This syndrome predominantly affects women and most commonly presents around the age of 42. It can develop spontaneously or be induced by factors such as the postpartum period or exposure to vasoactive substances. This case report describes an uncommon presentation of RCVS in a 24-year-old woman who developed an intraparenchymal hemorrhage shortly after a spontaneous vaginal delivery, despite the absence of conventional stroke risk factors. Diagnostic imaging with digital subtraction angiography (DSA) revealed multifocal vasoconstriction in the right and left anterior and middle cerebral arteries, along with the vertebrobasilar system, an indication of RCVS. Notably, vasoconstriction improved following intra-arterial nimodipine administration. This case underscores the importance of considering RCVS in postpartum women presenting with headaches and neurological deficits, as timely magnetic resonance imaging, computed tomography (CT) angiography, or brain angiography is critical for accurate diagnosis and optimal management, ultimately reducing the risk of poor prognosis.