Prolonged and recurrent reversible cerebral vasoconstriction syndrome in the postpartum period

Reversible cerebral vasoconstriction syndrome (RCVS) can develop in the early postpartum period and generally has a good prognosis. A 35-year-old woman developed postpartum RCVS, which had started as severe headache after a blood transfusion; a diagnostic cerebral angiogram showed diffuse vasospasm of intracranial vessels. Her clinical course was complicated by subarachnoid haemorrhage, strokes, seizure and recurrent vasospasm, which lasted for 4 weeks. The vasospasm was refractory to nifedipine and nimodipine but improved with intra-arterial verapamil, followed by oral verapamil and magnesium oxide.