Postpartum intracerebral and intraventricular hemorrhage – A case report and review of the literature

Background

Postpartum intracerebral hemorrhages (ICH) and intraventricular hemorrhages (IVH) are rare but potentially life-threatening conditions. They are often precipitated by hypertensive disorders, such as preeclampsia. Thus, the peripartum period is a critical time for monitoring female patients, particularly those at risk of hypertensive emergencies.

Clinical presentation

A 32-year-old female with no previous history of hypertension presented with severe headaches and elevated blood pressure (197/104 mmHg) seven days after delivery. Immediate brain computed tomography (CT) scan revealed the presence of a large ICH and IVH involving all 4 ventricles. Subsequently, the patient’s Glasgow Coma Scale (GCS) dropped rapidly (from 13/15–8/15) and a new brain CT scan revealed an increase in the intracerebral and intraventricular hemorrhage volume. Immediate surgery was performed, which consisted of decompressive craniectomy, ICH evacuation and placement of an external ventricular drain (EVD). The patient’s postoperative course showed significant recovery with upper moderate disability at 6 months follow-up based on the Glasgow Outcome Scale Extended (GOS-E) and scoring 3 out of 6 based on a modified Rankin scale score.

Conclusion

Timely neurosurgical intervention—including decompressive craniectomy, hematoma evacuation, and EVD placement—can significantly improve outcomes in postpartum patients with ICH and IVH, even in cases with rapid neurological decline. Clinicians should act swiftly when postpartum hypertension and neurological symptoms arise, as early diagnosis and intervention are critical to reducing mortality and long-term disability.