Abstract

Vertebral artery dissection (VAD) is recognized as a cause of stroke in the young with increasing frequency, and dissection has been described in association with pregnancy or puerperium. A 27-year-old female was admitted to our department due to the abrupt onset of pain in her posterior neck and occipital head, right Horner's sign, dysphonia, dysphagia, truncal ataxia and numbness in the left extremities one week after a normal pregnancy. Neurological examination revealed a right Wallenberg syndrome. Color Doppler ultrasonography detected an occlusion of the right vertebral artery and dissection of the artery was confirmed magnetic resonance angiography. Magnetic resonance imaging (MRI) showed an infarction in the right postero-lateral medulla oblongata and in the right cerebellar hemisphere. Hematological studies confirmed the diagnosis of protein S deficiency. The patient was given low-molecular-weight heparin therapy and had no further neurologic deterioration. VAD should be suspected in every patient with ischemic symptoms or signs related to the vertebrobasilar territory. The combination of protein S deficiency and the further reduction due to pregnancy may enhance the risk of major thrombotic episodes in the peripartum period.