Basilar artery embolism complicated with ovarian hyperstimulation syndrome: A case report

Abstract

A 37-year-old woman had received human menopausal gonadotropin-human chorionic gonadotropin (hMG-hCG) therapy for sterility. An abdominal ultrasound examination on the 15th day of hMG-hCG therapy revealed ovarian hypertrophy and ascites, leading to a diagnosis of ovarian hyperstimulation syndrome. The patient suddenly became comatose with decerebrated rigidity, bilateral mydriasis with absent light reflex, and doll's eye phenomenon on the 20th day of hMG-hCG therapy. Blood tests revealed an elevated red blood cell and hematocrit. Serum examination showed a high level of thrombin-antithrombin III complex, D-dimer, FDP and a estradiol, and low level of antithrombin III. Cerebral angiography revealed an occlusion of the left posterior cerebral artery. The occluded artery was partially recanalized by local thrombolysis using tissue plasminogen activator. Magnetic resonance imaging after the treatment showed an infarction in the bilateral midbrain and thalami. The patient settled in her disability with disorientation and upper gaze palsy. We suppose that ovarian hyperstimulation syndrome induced the hypercoagulability, which in larn led to the basilar artery embolism in this case.