A case of top of the basilar syndrome after a cesarean section due to reversible cerebral vasoconstriction syndrome

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  • 帝王切開後に可逆性脳血管攣縮症候群により脳底動脈先端症候群を来した1例

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A 31-year-old woman was started on oral methylergometrine following a scheduled cesarean section. After experiencing thunderclap headache on postpartum day 5, she developed generalized convulsions. Magnetic resonance (MR) imaging and MR angiography revealed multiple cerebral infarctions and cerebrovascular stenosis, and top-of-the-basilar syndrome due to reversible cerebral vasoconstriction syndrome (RCVS) was suspected. Treatment was started with cilostazol, edaravone, and verapamil. MR imaging performed on disease day 40 showed improvement of cerebrovascular stenosis; therefore, RCVS was definitively diagnosed. Sequelae included quadriparesis, dysarthria, and dysphagia. Modified Rankin scale score was 4, and the patient was subsequently transferred to another hospital for rehabilitation. RCVS reportedly shows good outcomes in most cases; however, it may represent a risk factor for residual sequelae in patients with severe basilar artery stenosis. Early treatment of RCVS should therefore be considered in such cases. Moreover, given the risk of RCVS onset, administration of methylergometrine to postpartum patients with a history of migraine headaches should be carefully considered.

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