Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2022; 10(26): 9478-9483
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9478
Common carotid artery thrombosis and malignant middle cerebral artery infarction following ovarian hyperstimulation syndrome: A case report
Yan-Ting Xu, Qian-Qian Yin, Zhao-Rong Guo
Yan-Ting Xu, Qian-Qian Yin, Zhao-Rong Guo, Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, Weihai 264400, Shandong Province, China
Author contributions: Guo ZR contributed to conception and design and provided study materials and patient information; Xu YT and Yin QQ was in charge of collection and assembly of data; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao-Rong Guo, MM, Doctor, Department of Obstetrics and Gynecology, Weihai Central Hospital Affiliated to Qingdao University, No. 3 West of Mishan East Road, Wendeng District, Weihai 264400, Shandong Province, China. gzhr0631@163.com
Received: April 27, 2022
Peer-review started: April 27, 2022
First decision: May 12, 2022
Revised: May 31, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: September 16, 2022
Processing time: 127 Days and 21.4 Hours
Abstract
BACKGROUND

Arterial thrombosis is a serious and rare complication of ovarian hyperstimulation syndrome (OHSS). Herein, we describe a case of OHSS complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction after egg retrieval and before embryo transfer.

CASE SUMMARY

A 32-year-old female with a family history of thrombosis who was undergoing in vitro fertilization due to unexplained infertility, was admitted due to abdominal distension for 3 d and coma for 2 h. She received egg retrieval 7 d ago and embryo transfer had not yet been performed. Blood biochemical analysis showed estrogen of 15781 pmol/L. Gynecological examination showed palpable masses on both sides of the adnexal areas. Ultrasound observed enlarged ovaries and abdominal ascites. Imaging examination of the head and neck revealed fresh malignant middle cerebral artery infarction in the left side of brain and internal carotid artery as well as occlusion in the left carotid artery, internal carotid artery, and middle cerebral artery. The patient was finally diagnosed with severe OHSS, complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction. Liquid replacement, anticoagulation, vascular endothelium protection, brain protection and decompressive craniectomy were carried out. Rehabilitation training was then performed for 6 mo. At present, she has poor speaking ability and decreased muscle strength on the right side.

CONCLUSION

There is a risk of thrombosis during any period of OHSS. During in vitro assisted reproduction, for cases with a family history of thrombosis, hyperlipidemia and other high-risk factors, serum lipid levels should be controlled as soon as possible to improve metabolic dysfunction. When thrombosis occurs, timely and effective treatment should be performed to improve the prognosis.

Keywords: Ovarian hyperstimulation syndrome; Arterial thrombosis; Cerebral infarction; Thrombophilia; Case report

Core Tip: Arterial thrombosis is a serious and rare complication of ovarian hyperstimulation syndrome (OHSS), which can be life-threatening without timely treatment. Herein, we report a case of OHSS complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction after egg retrieval and before embryo transfer. Based on the characteristics of this case, we conclude that thrombosis may occur during any period of OHSS. During in vitro assisted reproduction, for cases with high risk factors for thrombosis (such as hyperlipidemia), metabolic dysfunction should be corrected. When thrombosis occurs, timely and effective treatment should be performed to improve the prognosis.