Reporting on Adverse Clinical Events

A 35-year-old female patient developed throbbing headaches approximately 5 days after the delivery of a newborn. Additional symptoms, which appeared 10 days after delivery, included tongue heaviness, difficulty speaking, right-sided weakness, tingling, and decreased sensation. No medications were noted in the report but the patient admitted to a long history of chewing khat. A physical examination on hospitalization revealed normal results with the exception of the neurological examination, which indicated a right facial droop and reduced power of her right upper and lower extremities. Laboratory values were within normal limits, and screenings for infectious etiologies were negative. However, a magnetic resonance imaging of the brain revealed an acute left frontal lobe ischemic infarct. A magnetic resonance angiography of the head indicated vasoconstriction of the proximal anterior, middle, and posterior cerebral arteries. A diagnosis of postpartum reversible cerebral vasoconstriction syndrome was decided. Treatment included the administration of verapamil. Follow-up at 1 week demonstrated significant improvement in the vasospasm with complete resolution noted at a 3-month follow-up. The authors concluded that khat ingestion (chewing) was a contributing factor as a vasoactive substance in the development of postpartum reversible cerebral vasoconstriction syndrome in this patient. The authors suggested that clinicians be aware of the possible effects of khat and its use. Khat [Khat] Baharith H & Zarrin A (H Baharith, Department of Medicine, New York Methodist Hospital, Brooklyn, NY; e-mail: Harith.baharith@medportal.ca) Khat—a new precipitating factor for reversible cerebral vasoconstriction syndrome: a case report. J Med Case Rep 10:351 (Dec) 2016