Disclosures: Christopher P. Kyriakides, DO: No financial relationships or conflicts of interest

Case Description: A 38-year-old G1P0 woman with recent uneventful pregnancy with delivery by Cesarean section 3 days prior presented with headache, vomiting, confusion, and left-sided weakness. Work up demonstrated large right frontal intracerebral hemorrhage with vasogenic edema resulting in severe localized brain compression and mass effect with right-to-left midline shift. She underwent emergent right frontal parietal temporal craniotomy and evacuation of hemorrhage. She was started on antiepileptics for suspected seizure activity and high dose steroid therapy for suspected vasculitis.

Setting: Acute Rehabilitation

Patient: 38-year-old woman with a history of Erythema Multiforme and oral ulcers who developed right frontal intracerebral hemorrhage with residual left-sided hemiparesis after childbirth. Assessment/

Results: Patient was admitted to acute inpatient rehabilitation with significant left hemiparesis and cognitive deficits. She experienced significant psychological distress from being unable to care for her new infant including the inability to breast feed due to her medications. She benefited from consultation with in-house neuropsychologists, lactation specialists, and child life specialists. Intensive physical and occupational therapy focused on home mobility safety and simulated childcare activities. We coordinated management with neurology and rheumatology for diagnosis of the etiology of her postpartum intracerebral hemorrhage. She made significant motor, cognitive, and functional gains made by time of discharge home.

Discussion: A 2017 meta-analysis (cite) estimated pregnancy-related ICH to be 12.2 per 100,000 deliveries, with the highest risk during the peripartum and postpartum periods. Residual deficits such as hemiparesis present unique challenges to this patient population. Mothers of newborns require repetitive, task-specific rehabilitation to enhance their ability to perform tasks essential to childcare. Inpatient coordination of multidisciplinary care successfully addressed this patient’s medical, psychological, and functional needs.

Conclusion: Acute rehabilitation and physiatrist-coordinated care are essential for functional improvement and increased quality of life in stroke patients. This is especially true for women during the puerperal period when activities of daily living include caring for a newborn.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/motor-recovery-in-postpartum-cerebral-angiopathy-with-reversible-cerebral-vasoconstriction-syndrome-and-secondary-cns-vasculitis/