Mechanical Thrombectomy for Middle Cerebral Artery Occlusion Suspected of Ovarian Hyperstimulation Syndrome: Case Report and Review of the Literature

Abstract

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic disorder associated with infertility treatment. The main pathology of OHSS is intravascular dehydration and hyperestrogenemia. In mild cases, abdominal symptoms are the main symptoms, but in severe cases, thrombosis such as cerebral infarction may occur. A 36-year-old woman was undergoing infertility treatment in obstetrics and gynecology for infertility. She received HMG-HCG therapy and artificial insemination 1 week before onset, and on the day of onset she had mild abdominal distension and was suspected of having OHSS. She was prescribed aspirin for prevention of thrombosis. She presented with right upper hemiparesis and aphasia. Magnetic resonance imaging showed left middle cerebral artery occlusion. We performed mechanical thrombectomy and finally achieved Thrombolysis in Cerebral Infarction 3 recanalization. We suspected embolism as the etiology of cerebral infarction and started anticoagulation therapy. Various examinations were conducted to investigate the embolism source, but no anatomic abnormality or thrombophilia factors were observed. Because the patient had OHSS since admission, we concluded that OHSS was suspected as the cause of the stroke. We experienced the first case of mechanical thrombectomy for middle cerebral artery occlusion suspected to be caused by OHSS. It is necessary to suspect OHSS involvement if young women, especially those on infertility treatment, show neurologic deficits.