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Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intra-arterial rt-PA

From the Department of Obstetrics & Gynecology, Division of Reproductive Medicine (Drs. Elford and Leader); Department of Radiology, Division of Neuroradiology (Dr. Wee); and Department of Medicine, Division of Neurology (Dr. Stys), Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.

Address correspondence and reprint requests to Dr. Peter K. Stys, Ottawa Health Research Institute, Division of Neuroscience, 725 Parkdale Ave., Ottawa, ON K1Y 4K9, Canada; e-mail: pstys{at}ohri.ca

Ovarian hyperstimulation syndrome (OHSS) caused by fertility medications can predispose women to thrombosis. The authors present a case of a previously healthy woman who underwent in vitro fertilization and experienced a middle cerebral artery thrombosis that was subsequently lysed with intra-arterial recombinant tissue plasminogen activator (rt-PA). To the authors’ knowledge, this is the first reported case of successful use of rt-PA to lyse a cerebral arterial thrombus resulting from severe OHSS. The patient made a near complete neurologic recovery and delivered a healthy infant at term, illustrating that intra-arterial thrombolysis can be used with relative safety even in very early pregnancy.

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