Lymphocytic hypophysitis is a rare inflammatory autoimmune disorder of the pituitary gland/stalk that can occur in the postpartum period or in the third trimester. Typically, these lesions can present with visual symptoms due to impingement of the optic chiasm in addition to symptoms of headache and hypopituitarism. Pituitary apoplexy can present similarly in the setting of postpartum hemorrhage (Sheehan syndrome) [49]. Headache Arteriography Cervicocerebral There is no relevant literature to support the use of cervicocerebral arteriography in the initial imaging evaluation of new headache during pregnancy or peripartum period. CT Head With IV Contrast There is no relevant literature to support the use of CT head with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period. CTA Head With IV Contrast There is no relevant literature to support the use of CTA head with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period, unless there is TCH and suspicion for aneurysmal SAH or RCVS (also refer to Variant 1). Overall, the risk of intracerebral hemorrhage in pregnant women is rare; however, the risk of SAH rises dramatically in the postpartum period. As such, these patients may present with a classic TCH, and etiologies for SAH should be considered. Other conditions such as arterial dissections are also seen in pregnancy and are usually associated with preeclampsia [51]. After an initial head CT, a concurrent or follow-up CTA is useful in suspected cases of intracranial aneurysm (ruptured or unruptured), arterial dissection, and RCVS, which can occur within the first month of pregnancy and most often within 10 days [10-12,18,49].
Headache PCAs. Lymphocytic hypophysitis is a rare inflammatory autoimmune disorder of the pituitary gland/stalk that can occur in the postpartum period or in the third trimester. Typically, these lesions can present with visual symptoms due to impingement of the optic chiasm in addition to symptoms of headache and hypopituitarism. Pituitary apoplexy can present similarly in the setting of postpartum hemorrhage (Sheehan syndrome) [49]. Headache Arteriography Cervicocerebral There is no relevant literature to support the use of cervicocerebral arteriography in the initial imaging evaluation of new headache during pregnancy or peripartum period. CT Head With IV Contrast There is no relevant literature to support the use of CT head with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period. CTA Head With IV Contrast There is no relevant literature to support the use of CTA head with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period, unless there is TCH and suspicion for aneurysmal SAH or RCVS (also refer to Variant 1). Overall, the risk of intracerebral hemorrhage in pregnant women is rare; however, the risk of SAH rises dramatically in the postpartum period. As such, these patients may present with a classic TCH, and etiologies for SAH should be considered. Other conditions such as arterial dissections are also seen in pregnancy and are usually associated with preeclampsia [51]. After an initial head CT, a concurrent or follow-up CTA is useful in suspected cases of intracranial aneurysm (ruptured or unruptured), arterial dissection, and RCVS, which can occur within the first month of pregnancy and most often within 10 days [10-12,18,49].