Teaching Video NeuroImage: Reversible Caudate Changes in a Patient With Post-Pump Chorea

A 28-year-old woman with no significant family history presented with a 4-week complaint of involuntary movements after a pulmonary endarterectomy requiring deep hypothermic circulatory arrest (Video 1). Brain MRI revealed bilateral caudate T2 hyperintensity, which resolved after 3 months (Figure). Tetrabenazine initially controlled her generalized chorea and was subsequently withdrawn by 6 months with near-complete resolution of symptoms. Post-pump chorea is rare, often occurring in children after cardiopulmonary surgery and presenting with several distinct imaging findings.1 Risk factors include circulatory arrest and prolonged deep hypothermia. Although the prognosis varies, some patients have a complete resolution of chorea within months.1,2

Figure Brain MRI Demonstrating Bilateral Caudate T2 Hyperintensity

(A) completely resolved after 3 months (B). Although the mechanism for such findings remains poorly understood, studies have suggested the possibility of mismatch between cerebral blood flow and brain metabolism as a result of rewarming.2

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Appendix Authors

  • Received October 29, 2021.
  • Accepted in final form February 21, 2022.

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