MRI features of acute bilateral caudate infarcts in pregnant woman

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.