Cerebral infarction in a surviving monochorionic twin: A case report

Intrauterine death of one member of a twin pair in a monochorionic pregnancy is associated with increased morbidity and mortality rates for the surviving twin. Many organs of the surviving twin may be damaged, especially the central nervous system. We present a case of cerebral infarction confirmed using magnetic resonance imaging (MRI) in a survivor after the intrauterine death of a co-twin. A 33-year-old woman had a normal twin pregnancy until 38 weeks' gestation when she delivered a stillborn fetus and a live infant. The surviving twin underwent cranial ultrasonography (US) study 1 day after birth which showed a hyperechoic lesion over the right posterior parietal region. The follow-up cranial US on day 21 revealed cystic encephalomalacia in right posterior parietal lobe involving the right postcentral gyrus and angular gyrus. MRI of the head confirmed focal cystic encephalomalacia over the right posterior parietal lobe at the age of 36 days. We discuss the possible causes of cerebral infarction in our patient and also review some of the literature.