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Case Records of the Massachusetts General Hospital
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Volume 360:1126-1137 March 12, 2009 Number 11
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Case 8-2009 — A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum
Aneesh B. Singhal, M.D., W. Taylor Kimberly, M.D., Ph.D., Pamela W. Schaefer, M.D., and E. Tessa Hedley-Whyte, M.D.

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Presentation of Case

Dr. W. Taylor Kimberly: A 36-year-old woman was admitted to the hospital because of headaches, hypertension, and seizures.

Nineteen days before the current admission, she delivered healthy twins at 35.6 weeks of gestation by cesarean section (for breech presentation) at another hospital. She was discharged on the fifth day. Nine days before the current admission, she began to have intermittent, throbbing, bifrontal headaches, and 2 days later she saw her gynecologist. She rated the pain as 8 (on a scale of 0 to 10, with 10 being the most severe pain). The blood pressure was 150/72 mm Hg. She was . . . [Full Text of this Article]

Differential Diagnosis

Primary Headache Disorders

Subarachnoid Hemorrhage

Cerebral-Artery Dissections and Venous Sinus Thrombosis

Postdural Puncture Headache

Delayed Postpartum Eclampsia

Pregnancy-Related Stroke

Primary Angiitis of the Central Nervous System

Reversible Cerebral Vasoconstriction Syndrome (Postpartum Angiopathy)

Clinical Diagnosis

Pathological Discussion

Anatomical Diagnoses


Source Information

From the Department of Neurology (A.B.S.), Partners Neurology Residency Program (W.T.K.), and the Departments of Radiology (P.W.S.) and Pathology (E.T.H.-W.), Massachusetts General Hospital; and the Departments of Neurology (A.B.S., W.T.K.), Radiology (P.W.S.), and Pathology (E.T.H.-W.), Harvard Medical School.



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