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 Tetrabenazine initially controlled her generalized chorea and was subsequently withdrawn by 6 months with near-complete resolution of symptoms.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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