Postpartum cerebral arterial dissections

Figures

• 

  Figure 1. Diffusion weighted imaging (DWI) of the head magnetic resonance imaging (MRI) and angiography (MRA) were performed in the woman before admission. A & B. DWI imaging revealed multiple lesions of acute infarction in the right frontal and parietal lobes. C. MRA showed occlusion of right internal carotid artery.

• 

  Figure 2. Cervical vascular ultrasound and transcranial Doppler (TCD) examination. A. Cervical vascular ultrasound showed a membrane structure with moderate echo in the lumen of the right common carotid arteries, pulsating with the blood flow. Low echo could be detected in the lumen of the lesion, resulting in local severe stenosis of the common carotid artery and distal occlusion of the internal carotid artery. The initial diagnosis was carotid arterial dissection with intramural hematoma. B & C. The pulsation of bilateral middle cerebral arteries was low, especially on the right side, and the low velocity blood flow signal was detected in the left vertebral artery, with relatively high resistance changes. LVA = left vertebral artery.

• 

  Figure 3. Cervical magnetic resonance angiography (MRA) and head and neck computed tomography angiography (CTA). A & B. Cervical MRA demonstrated stenoses of bilateral carotid and vertebral arteries with crescent signal in the lumen of bilateral carotid arteries and right vertebral artery extracranial segment. C & D. Head and neck CTA displayed diffuse lesions with aneurysm-like changes in bilateral carotid and vertebral arteries.

• 

  Figure 4. Digital subtraction angiography of the whole brain showed multiple stenoses in right (A) and left (B) internal carotid arteries and right (C) and left (D) vertebral arteries, with poor blood flow to the distal arterial branches.

• 

  Figure 5. Transcranial Doppler and cervical vascular ultrasound. A. Transcranial Doppler 2 months after discharge demonstrated that the blood flow velocity and pulsatility index in the middle cerebral artery were significantly increased, and the spectrum of intracranial artery was improved. B. Cervical vascular ultrasound 6 months after discharge revealed no vascular abnormality. LMCA = Left middle cerebral artery; RCCA = right common carotid artery; RICA = right internal carotid artery; RMCA = right middle cerebral artery.

• 

  Figure 6. Magnetic resonance angiography (MRA) and computed tomography angiography (CTA). A & B. Head and neck MRA 6 months after discharge revealed nothing abnormal. C. Head and neck CTA 3.5 years after discharge demonstrated nothing abnormal.