IVIG as a Cause of Fatal Acute Ischemic Stroke: Case Report and Systematic Review

Purpose— To highlight the role of intravenous immunoglobulin (IVIG) in patients with malignant acute ischemic
stroke.
Case Description—A 39-year-old woman developed posterior cerebral artery infarctions bilaterally without
any large arterial occlusion identified on CT angiography after being treated with IVIG for acute inflammatory
demyelinating polyneuropathy. The patient’s neurological deficits progressed to brain death over the next 36 hours.
Literature Review— A comprehensive and systematic review of the literature concerning IVIG administration
associated with ischemic and/or embolic events was conducted, and a total of 24 articles were included for review.
Thirteen (54.2%) studies described post-IVIG stroke, 6 (25.0%) cerebral infarction, 6 (25.0%) deep vein thrombosis,
5 (20.8%) myocardial infarction, 3 (12.5%) pulmonary embolism, 2 (8.3%) multiple embolic events, and 4 (16.7%)
other embolic events. Review of the 24 included articles revealed that IVIG may be associated with a risk of embolic
and ischemic complications.
Summary— This case report and literature review highlight the need for studying the mechanism of association and
identifying new strategies to reduce ischemic stroke during or after IVIG administration.