Continuous arterial spin labeling perfusion magnetic resonance imaging findings in postpartum vasculopathy

Postpartum vasculopathy (PPV) is a rare heterogeneous nonatherosclerotic va sculopathy that occurs in the puerperium. It occurs spontaneously but may b e triggered by vasoconstrictor substances. The angiographic findings vary a nd include narrowing of the intracranial arteries and vasospasm. The angiog raphic findings and the occurrence of ischemic infarcts suggest that cerebr al blood flow (CBF) is impaired in PPV. The purpose of this study is to det ermine CBF in patients with PPV. The authors conducted a case study of 3 pa tients with clinical and laboratory criteria for PPV examined during a 2-ye ar period. Clinical examination, computed tomography imaging, structural ma gnetic resonance imaging (MRI), cerebral angiography, and continuous arteri al spin labeling perfusion (CASIL-PI) MRI were performed in all patients. M ean global CBF was determined, and perfusion maps were visually inspected. The CBF values and perfusion maps were correlated with the clinical symptom s and the neuroimaging findings. Three women were studied (22, 34, and 36 y ears old). The median time of presentation was 4 days postpartum. One prese nted with intracranial hemorrhage and diffuse arterial narrowing, the other 2 with stroke-like lesions, encephalopathy, and segmental narrowing mainly in the posterior circulation. CASL-PI was performed within 1 week of sympt om onset in all 3 patients. Global mean CBF values were 51.8, 39.3, and 41. 8 cc/100 g/min. Although global CBF was mildly diminished, it was above isc hemic levels. Visual inspection of the CASL-PI perfusion maps did not revea l areas of focal hypoperfusion or hyperperfusion. In this series of patient s with PPV, CBF was close to normal. Although angiography often reveals dif fuse arterial narrowing, the CBF values encountered in this study do not su pport a state of generalized or focal oligoemia. Vasomotor tone may change intermittently in patients with PPV.