2026 American Academy of Neurology Abstract Website

Objective:

The primary objective of this study was to describe the clinical presentation, neuroimaging findings, and outcomes of RCVS in the peripartum period.

Background:

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare but serious cause of headache characterized by multifocal vasospasm of large and medium-sized intracranial arteries. The peripartum period is a known trigger of RCVS, sometimes associated with pre-eclampsia and eclampsia.

Design/Methods:

Retrospective, multi-center descriptive analysis of women aged 18-45 years diagnosed with RCVS by clinical and radiographic findings between January 2016 and March 2025 during peripartum (pregnancy or within 12 months postpartum). Patients were identified using Epic SlicerDicer and a radiology informatics database. Demographics, medical history, obstetric details, presenting symptoms, neuroimaging findings, hospital course, and clinical outcomes were collected.

Results:

Among 17 peripartum RCVS patients, median age of 29 years, 13 were multiparous, with a median gravida of 4. Preeclampsia was present in 35% of patients. The distribution of time of delivery to RCVS event demonstrated two peaks, with a cluster within the first two weeks (9 patients) and a second delayed cluster after 100 days (6 patients). Only 1 event occurred during pregnancy. All patients reported headaches on presentation.

Focal neurological deficits were present on admission in 6 patients, blurred vision in 4 patients, and one patient had seizure on presentation. Neuroimaging findings included intracerebral hemorrhage (3/17, 2 of which were symptomatic), subarachnoid hemorrhage (6/17), and cerebral ischemia (4/17, 3 of which were symptomatic). Of all patients, including those with stroke complications, only 2 patients were discharged to acute rehab prior to home; 2 patients experienced ongoing focal neurological deficits at discharge and follow up.

Conclusions:

Peripartum RCVS typically presents in the first two weeks postpartum with headache. Despite complications such as intracerebral hemorrhage and cerebral ischemia, most patients have favorable prognosis with minimal residual deficits.