Leonardo de Sousa Bernardes
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Raphael Palomo Barreira
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Marina Trombin Marques
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Danyelle Sadala Reges
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Vivian Dias Baptista Gagliardi
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Background: Carotid or vertebral artery dissection is a rare puerperium event, occurring in less than 6% of cases. Although physiopathology is not completely understood, it is probably multifactorial involving increased cardiac output, hypervolemia and hormonal changes remodeling endothelium and favoring dissection. Most patients present headache and neck pain, but it is also reported Horner syndrome, tinnitus, retroorbital pain and cranial nerve palsies. Case Report: Female, 39-year-old patient in the 20th day of puerperium presents a sudden headache with transitory left hemiparesis and dysarthria for 30 minutes. Magnetic Resonance Imaging (MRI) with angioresonance revealed an area of right middle cerebral artery (MCA) infarction and right internal carotid artery dissection in the cervical segment with a large intraluminal thrombus. The diagnosis was stablished as ischemic stroke caused by carotid dissection. Transcranial doppler presented post stenotic flow in the right MCA, flow inversion in the right anterior cerebral artery (ACA) and ipsilateral collateral circulation of the external carotid artery. After two months on double antiplatelet treatment (apirin 100mg and clopidogrel 75mg), it was partially recanalized and there was improvement in the collateral and hemodynamic pattern. Conclusion: Puerperium pacients describing intense headache or neck pain should be investigated with MRI and angioresonance of intracranial and cervical vessels. In the cervical arterial dissection it is recommended double antiplatelet therapy, for three to six months.
Internal Carotid Artery Dissection during Puerperium: A Case Report