Postpartum Syncope with a New Onset of Headache: a Case Report

Postpartum period is an especially vulnerable period of time. Headache, dizziness, and loss of consciousness are not uncommon in patients who are immediately postpartum. In order to rule out potentially fatal causes such as intracranial hemorrhage, monitoring of clinical signs and offering diagnostic studies are of essential. Here we present a case with a new headache in the postpartum period after a syncope fall accident, and an intracranial vascular malformation noted in subsequent radiologic evaluation. A 36-year-old woman without underlying condition developed severe headache following a syncope fall accident after a vaginal delivery. An intracranial vascular malformation was noted in the brain CT scan, and MR imaging and digital subtraction angiography revealed a mixed lesion of a cavernous malformation and a developing venous anomaly. Due to hemodynamic fluctuation, headache or syncope is not an uncommon sign in the postpartum period. When companied with worrisome features, these symptoms require further investigation. Our patient was diagnosed to have a mixed vascular malformation, which is a coexistence of a developing venous anomaly and a cavernous malformation. After the diagnosis was confirmed, the possible need for surgical intervention and future rebleeding risk, especially in the next pregnancy, should be evaluated. Previous studies concluded that pregnancy, delivery and puerperium were not associated with an increased hemorrhage risk, and the selection of delivery mode in patients with known cavernous malformation should be based on general obstetric indications. Primary care providers need to identify worrisome signs related to intracranial hemorrhage in postpartum patients with syncope, dizziness, or headache. In patients diagnosed to have an intracranial vascular malformation in this period of time, it is most important to make prompt diagnosis and refer her to a specialist for further treatment and counseling.