Abstract
A 20-year-old female, in her 20th week of pregnancy, was hospitalized due to recurrent, severe vomiting, dehydration, somnolence and bilateral upper limbs athetosis. Metabolic status revealed ketonuria, proteinuria and hypokalemia. After urgent laparoscopy due to acute abdomen, the patient became hemodynamically unstable, with respiratory insufficiency and mechanical ventilation was applied. After stabilizing mental and clinical status, extubation procedure was performed. Neurological examination revealed psychomotor slowing, apathy, hyperreflexia and right sided rigor. Magnetic resonance imaging (MRI) of the brain revealed symmetric infarcts in head of both caudate nuclei. High signal intensity lesion on axial diffusion weighted image (DWI, b-1000 (Fig. A) in the head of both caudate nuclei and low signal on apparent diffusion coefficient image (Fig. B), in keeping with acute infarcts. Management of the patient included correction of fluid and potassium deficit and secondary stroke prevention with aspirin.
Highlights
High signal intensity lesion on axial diffusion weighted image (DWI, b-1000 (Fig. A) in the head of both caudate nuclei and low signal on apparent diffusion coefficient image (Fig. B), in keeping with acute infarcts
Small vessel disease is the predominant cause followed by cardioembolic and underlying carotid disease, but presumed cause in this pregnant patient was the systemic hypoperfusion due to hypovolemic shock
Bilateral caudate infarcts were previously attributed to frontal behavioral syndrome, often associated with significant memory impairment
Summary
High signal intensity lesion on axial diffusion weighted image (DWI, b-1000 (Fig. A) in the head of both caudate nuclei and low signal on apparent diffusion coefficient image (Fig. B), in keeping with acute infarcts. Potassium deficit and secondary stroke prevention with aspirin.
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