94 Acta Neurologica Taiwanica Vol 17 No 2 June 2008 From the 1 Division of Neurology, Taichung Veterans General Hospital, 2 Department of Internal Medicine, National Yang- Ming University, and 3 Graduate Institute of Biomedicine and Biomedical Technology, National Chi-Nan University, Taiwan. Received May 4, 2007. Revised October 3, 2007. Accepted January 7, 2008. Reprint requests and correspondence to: Peiyuan F. Hsieh, MD. Division of Neurology, Taichung Veterans General Hospital. No. 160, Sec. 3, Taichung-Kang Rd., Taichung, Taiwan. E-mail: pfhsieh@vghtc.gov.tw INTRODUCTION During pregnancy and the puerperium, the incidence of stroke increases threefold to 13-fold (1) . The estimated risk of a peripartum stroke is 13.1 cases per 100,000 deliveries (2) . Of approximately 50,700 admissions for delivery, 34 patients with a diagnosis of stroke were identified (21 infarctions and 13 hemorrhages) (3) . Possible explanations for this increased incidence include hormonal changes, dehydration and intrinsic hypercoagulation during pregnancy, vascular trauma during delivery, and the contraction of the blood volume postpartum. Although stroke and carotid artery dissection are not frequent causes of headache during pregnancy and the postpartum period, they should be included in the differ- ential diagnosis. We report on the combined carotid and vertebral artery dissections superimposed with contralat- Unilateral Carotid and Vertebral Artery Dissections and Contralateral Subarachnoid Hemorrhage in a Postpartum Patient Peiyuan F. Hsieh 1,2,3 , Yi-Chung Lee 1,2 , and Ming-Hong Chang 1,2 Abstract- Postpartum arterial dissection combined with subarachnoid hemorrhage (SAH) is rare and its mechanism is uncertain. A 32 year-old woman had a delivery by cesarean section 12 days prior to admission to our hospital. From the first day of delivery, she breast-fed her baby, sitting with her head always turned to the right. Each feeding lasted around 2 hours. A bilateral throbbing headache began two days after child- birth, and intermittent numbness of the right face, chest and hand as well as weakness of the right hand developed nine days after giving birth. A physical examination revealed transient mild hypertension and right hemiparesis. Her cholesterol ranged from 204 to 263 mg/dl. Computed tomography, magnetic reso- nance angiography and duplex ultrasound disclosed left fronto-parietal junction SAH and dissections of the right internal carotid (ICA) and vertebral arteries. Our patient demonstrated (1) that postpartum arterial dis- section was not limited to natural delivery, (2) postpartum SAH could occur with dissections of the con- tralateral extracranial carotid and vertebral arteries, and (3) that turning one’s head always to the same side during breast-feeding might be a risk factor for this unusual stroke pattern. Key Words: Postpartum, Breast-feeding, Arterial dissection, Subarachnoid hemorrhage Acta Neurol Taiwan 2008;17:94-98 Case Reports