Postpartum Internal Carotid and Vertebral Arterial Dissections

Kelly, Jeannie C. MD; Safain, Mina G. MD; Roguski, Marie MD; Edlow, Andrea G. MD, MSc; Malek, Adel M. MD, PhD

doi: 10.1097/AOG.0000000000000189
Contents: Original Research

OBJECTIVE: Headache and neck pain are common postpartum symptoms. However, these symptoms can rarely be associated with internal carotid artery and vertebral artery dissections. We aimed to review five cases of postpartum cervical artery dissection and to review the clinical course of previously reported cases.

METHODS: Patients with postpartum dissections diagnosed at our institution since 2005 were identified through a database maintained by the senior author, and their clinical data were reviewed. Additionally, a literature search for previously reported cases was performed, and the clinical data in those reports were reviewed.

RESULTS: Five patients presented with cervical artery dissections within 6 weeks postpartum. Four patients had delivered vaginally and one delivered by emergent cesarean. Headache and neck pain were the primary presenting symptoms of all five patients. Four patients demonstrated neurologic symptoms, and one had development of stroke. Two patients had single internal carotid artery dissections, one patient had bilateral dissections of the vertebral artery, and two patients had dissections in the internal carotid artery and vertebral artery. All patients were treated with either anticoagulation therapy or antiplatelet therapy. Two patients required endovascular stenting. Four of five patients returned to neurologic baseline after treatment. A literature search yielded 27 previously reported cases, with similar clinical characteristics of older reproductive age, presentation days to weeks from delivery, and recovery to neurologic baseline in the majority of patients.

CONCLUSION: Postpartum cervical dissections are rare occurrences that require prompt diagnosis to prevent long-term neurologic deficits. Individualized management strategies include medical treatment (anticoagulation therapy, antiplatelet therapy, or anticoagulation and antiplatelet therapy) and endovascular recanalization.

LEVEL OF EVIDENCE: III

Postpartum cervical artery dissections are rare occurrences that require prompt diagnosis to prevent long-term neurologic deficits; management strategies include medical therapies and endovascular recanalization.

Cerebrovascular and Endovascular Division, Department of Neurosurgery, and the Department of Obstetrics and Gynecology, Tufts Medical Center and Tufts University, Boston, Massachusetts.

Corresponding author: Adel M. Malek, MD, PhD, Department of Neurosurgery, Tufts Medical Center, 800 Washington Street, Boston, MA 02111; e-mail: amalek@tuftsmedicalcenter.org.

Financial Disclosure Dr. Malek has received research funding from Stryker Neurovascular, Codman Neurovascular, Microvention Inc., Covidien-ev3, and Siemens Inc. for unrelated research. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.