Reversible Cerebral Vasoconstriction after Preeclampsia
A 41-year-old woman underwent cesarean section for preeclampsia at 30 weeks of gestation. Two days after delivery, total visual loss occurred suddenly, followed by weakness of the left leg. Magnetic resonance imaging of the brain showed areas of restricted diffusion in both occipital cortexes, a finding that was consistent with acute infarction (Panel A). Magnetic resonance angiography (MRA) revealed generalized vasoconstriction of the anterior and posterior cerebral circulation (Panel B, arrows). The patient started to regain her vision after 12 hours, with almost complete recovery over the following days. Repeat MRA 4 weeks after the event revealed normalized vessel caliber, in keeping with reversible cerebral vasoconstriction (Panel C). Cerebral venous sinus thrombosis, the posterior reversible encephalopathy syndrome, and primary angiitis of the central nervous system should be considered initially in the differential diagnosis of reversible cerebral vasoconstriction.