Case 8-2009

Severe headaches associated with hypertension developed in a 36-year-old woman 10 days after delivery of twins by cesarean section; initial brain magnetic resonance imaging (MRI) and computed tomographic examinations were normal. Headaches persisted despite antihypertensive medications; a seizure and an episode of aphasia and hemiparesis occurred. Repeated MRI and magnetic resonance angiography showed posterior white-matter changes on T2-weighted sequences and multifocal narrowing and dilatation of intracranial arteries. A diagnostic procedure was performed.