Multiple Cerebral Infarctions Associated with Polycystic Ovaries and Ovarian Hyperstimulation Syndrome

no family history of cardiovascular disease, no use of oral contraceptive or preventive medication for stroke. She had been nulligravida before this pregnancy. Ultrasonographic examination of the ovaries was performed by the infertility clinic and revealed multiple, bilateral follicles, 0.5–0.7 cm in size. Induction of ovulation began 28 days prior to focal neurological symptoms. The patient received oral clomiphene citrate (100 mg/day for 5 days) and injection of human menopausal gonadotropin (75 IU/day for 5 days). Two weeks later, 15 oocytes were retrieved and 6 embryos were transferred: 3 in the right endometrium, 3 in the left. Two days prior to admission at our hospital, ascites was observed during abdominal ultrasound, and a diagnosis of OHSS was made. At admission, blood pressure was 120/70 mm Hg, with a regular pulse rate of 85/min. On examination, the patient was slightly drowsy, was unable to speak fluently but able to comprehend, had a left visual field defect and severe left-sided motor weakness, including central-type facial palsy. The initial National Institutes of Health Stroke Scale (NIHSS) score was 18. Laboratory tests demonstrated that the serum white blood cell count (21,830/ l) and levels of liver enzymes (aspartate aminotransferase 143 IU/l; alanine aminotransferase 86 IU/l) were elevated, while serum albumin was decreased (2.8 g/dl). Human chronic gonadotropin (hCG) was Dear Sir, Ovarian hyperstimulation syndrome (OHSS) is a potentially lethal complication of ovulation induction [1, 2] . OHSS can represent electrolyte imbalance, neurohormonal and hemodynamic changes, pulmonary manifestations, liver dysfunction, hypoglobulinemia, febrile morbidity and thromboembolic phenomena. Past studies have indicated that OHSS has a significant and consistent relationship with polycystic ovaries. When polycystic ovaries are present, OHSS can develop more frequently than in a normal female [3] . A thromboembolic phenomenon in OHSS is clinically important due to potential severe complications. Thromboembolism, combined with OHSS, occurs primarily in the venous system, but case reports of cerebral infarction in OHSS can also be found in the literature [4–6] . We report a case of massive and progressive cerebral infarction with OHSS and polycystic ovaries, occurring several days after in vitro fertilization and embryo transfer.