Cerebral Infarcts in the Setting of Eosinophilia

Abstract

To describe 3 cases of stroke associated with hypereosinophilic syndrome and discuss the pathogenesis of such strokes. Design: Retrospective medical record review. Setting: University hospital. Participants: Three patients who had strokes temporally correlating with eosinophilia with no other obvious causes of stroke. Intervention: Retrospective review of the hospital course, laboratory data, imaging, treatment, and outcome. Results: All 3 patients had multiple strokes in both hemispheres. Two patients with modest eosinophilia that was controlled quickly had infarcts mostly in arterial border zones and had good outcomes. The third patient with severe and more refractory eosinophilia had a poor outcome. Conclusions: Cardiac emboli and direct eosinophil toxicity contribute to strokes in hypereosinophilic syndrome. Prognosis is variable with use of anticoagulation and antiplatelet agents but rapid lowering of the eosinophil count results in a better outcome.

Eosinophilic cardiac disease: Molecular, clinical and imaging aspects

“…Thus, in cases of organized thrombi, oral anticoagulation therapy appears to be legitimate [38,39]. To prevent embolic events, the best target international normalized ratio value seems to be 3.0.…”

Multiple cerebral infarctions in a young patient with heroin-induced hypereosinophilic syndrome

“…In early HES, cerebral infarctions are usually small to medium sized and occur typically in border zone areas [2,6]. In contrast, cardioembolic stroke is usually territorial.…”

“…In addition to hematological and cardiac pathologies, neurological alterations such as inflammatory monoor polyneuropathies, stroke and psychological disorders have been described. In about 12% of the cases, HES leads to cerebral infarction [2]. Several cases of heroin induced hypereosinophilia have been previously described [3].…”

Hookworm With Hypereosinophilia: Atypical Presentation of a Typical Disease

“…8 The multiple cerebral microinfarctions around the basal ganglia, as seen on the patient's CT scan, could explain the coordination difficulties and would fit the diagnosis of hypereosinophilic encephalopathy. 9 The ulnaropathy could also be explained by an eosinophilic vascular mononeuropathy multiplex, but after electromyographic analysis, is more likely to be a pressure neuropathy due to the marked weight loss.…”