Hwang W J, Lai M L, Hsu C C, Hou N T
Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
J Formos Med Assoc. 1998 Jul;97(7):503-6.
We present a case of right middle cerebral artery occlusion after a controlled ovarian hyperstimulation regimen and cryopreserved embryo transfer (ET) in a previously healthy 22-year-old woman. The patient suffered from nausea and progressive abdominal distension 8 days after ET. Under the diagnosis of ovarian hyperstimulation syndrome, she was treated with hypertonic solution, albumin infusion, and paracentesis, with some improvement. Left hemiparesis and dysarthria occurred suddenly on the fourth day of hospitalization, 11 days after ET. The neurologic deficits progressed to complete hemiplegia within a few hours. Computed tomography of the head showed infarction in the territory of the right middle cerebral artery. Magnetic resonance angiography revealed occlusion of the main trunk of the right middle cerebral artery. Laboratory studies showed leukocytosis with neutrophil predominance and a hypercoagulable state. The pregnancy was terminated because of progressive tachycardia, dyspnea, and increased abdominal girth despite supportive treatment. The neurologic deficits remained stationary at the time of discharge. This case emphasizes that the recent advent of ovulation induction and assisted reproductive techniques is a newly recognized cause of devastating cerebral infarction in otherwise healthy women.
我们报告一例既往健康的22岁女性，在控制性卵巢过度刺激方案及冷冻胚胎移植（ET）后发生右大脑中动脉闭塞的病例。患者在胚胎移植后8天出现恶心及进行性腹胀。在诊断为卵巢过度刺激综合征后，她接受了高渗溶液、白蛋白输注及腹腔穿刺治疗，症状有所改善。住院第4天，即胚胎移植后11天，患者突然出现左侧偏瘫及构音障碍。数小时内神经功能缺损进展为完全性偏瘫。头颅计算机断层扫描显示右大脑中动脉供血区梗死。磁共振血管造影显示右大脑中动脉主干闭塞。实验室检查显示白细胞增多，以中性粒细胞为主，且处于高凝状态。尽管进行了支持治疗，但由于进行性心动过速、呼吸困难及腹围增加，终止了妊娠。出院时神经功能缺损仍无变化。该病例强调，排卵诱导和辅助生殖技术的近期出现是原本健康女性发生毁灭性脑梗死的一个新的公认原因。
