Approximately 3 days postpartum, this 38-year-old woman developed headaches in the context of increased blood pressure. She then noticed visual blurring, word-finding difficulties, and right-sided weakness.

This 38-year-old left-handed woman developed new-onset headaches in the context of increased blood pressure 3 days after delivery of healthy twins from her first pregnancy. She had no seizures and reported no prior history of migraine headaches. No vasoconstrictor drugs had been used, and no medications were given to suppress lactation.

She was initially diagnosed with migraine headaches and released from a local emergency room (ER). She was soon readmitted to an outside hospital with similar complaints and was diagnosed with postpartum preeclampsia. Cerebrospinal fluid (CSF) analysis showed 19 WBCs, 30 RBCs, a protein content of 73, and normal glucose concentration. She was diagnosed with aseptic meningitis and discharged home.

A few days later, she had loss of peripheral vision, word-finding difficulties, and right-arm weakness. She was found to have fluctuating blood pressure, right-left disorientation, finger agnosia, and dyscalculia. Magnetic resonance imaging (MRI) showed diffusion restriction involving the left posterior brain region. Magnetic resonance angiography (MRA) demonstrated multisegmental arterial narrowing of both middle cerebral arteries, both anterior cerebral arteries, and basilar artery. She was then suspected of having a primary central nervous system (CNS) angiitis and was transferred to our institution for further evaluation.