NCCEd: Neurocritical Care Education for Residents

OB/GYN is urgently consulted and agrees with our concern for needing to expedite delivery in the context of potential PRES/RCVS with preeclampsia. After a mutual discussion between our teams and anesthesia, the consensus is to proceed with emergent C-section followed by admission to the NCCU. The patient and her husband are scared but understand and agree to this plan of care.

The patient is whisked away to the OR and undergoes an uneventful C-section, with delivery of a healthy baby girl. She is admitted to the NCCU thereafter.

Back in the NCCU, her exam is roughly stable compared to what you initially observed. Over the next two hours, she experiences some worsening of her headache, dysarthria, as well as some subtle right hemiparesis. Her alertness and responsiveness never fluctuate, and she hasn't had any abnormal movements. You obtain a STAT NCHCT, which is unrevealing. The hematoma burden is stable. Ventricular caliber is stable. There's no apparent sulcal effacement.

Suggested Reading:

• Singhal AB. Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome as Syndromes of Cerebrovascular Dysregulation. Continuum (Minneap Minn). 2021;27(5):1301-1320. doi:10.1212/CON.0000000000001037
• Skeik N, Porten BR, Kadkhodayan Y, McDonald W, Lahham F. Postpartum reversible cerebral vasoconstriction syndrome: review and analysis of the current data. Vasc Med. 2015;20(3):256-265. doi:10.1177/1358863X14567976
• Lee DE, Krishnan A, Collins R. Reversible cerebral vasoconstriction syndrome in the postpartum period: A case report and review of the literature. Int J Gynaecol Obstet. 2023;162(3):823-828. doi:10.1002/ijgo.14756