Call-Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome

Abstract

Background: The postpartum angiopathy (Call-Fleming syndrome) is a rare, reversible cerebral vasoconstriction syndrome. Unlike in eclampsia, neither proteinuria nor hypertension have been observed in the Call-Fleming syndrome.

Case: A 17-year-old woman developed headache, seizures, confusion, cortical blindness, and denial of visual loss (optic anosognosia, Anton syndrome) on the first postpartum day. Transcranial Doppler demonstrated severely elevated blood velocities. Magnetic resonance angiography showed multifocal segmental narrowing of cerebral arteries. Magnetic resonance imaging revealed occipitotemporal edema. After symptomatic treatment, the clinical deficits disappeared completely within 2 weeks. The follow-up neuroimaging performed after 3 months was unremarkable.

Conclusion: The case shows that the Call-Fleming syndrome is a reversible condition with excellent prognosis representing an important differential diagnosis of eclampsia, dural sinus thrombosis, and intracranial bleeding in puerperium.