Postpartum reversible cerebral vasoconstriction syndrome: a rare but severe cause of postpartum headache

Postpartum reversible cerebral vasoconstriction syndrome (RCVS), also known as postpartum cerebral angiopathy, is an uncommon but potentially serious cause of thunderclap headache. Early diagnosis is challenging, and there may be a misdiagnosis due to non-specific clinical presentation and frequently normal initial imaging studies. We report a case of a primigravid woman in her early 30s who developed a sudden, severe holocranial headache on the fourth postpartum day, with no associated neurological findings. Initial head CT, CT angiography, cerebral CT venography and MRI showed no abnormalities. However, digital subtraction angiography (DSA), revealed multifocal segmental narrowing of intracranial arteries, with complete reversibility after 3 months, consistent with RCVS. The patient was treated with oral nimodipine and experienced gradual symptom resolution. There was no complication associated, with no recurrence so far.