Hypereosinophilia–An Unusual Cause of Multiple Embolic Strokes and Multi-Organ Dysfunction

Khwaja, Geeta Anjum; Duggal, Ashish; Kulkarni, Amit; Choudhary, Neera; Gupta, Mukesh Kumar; Chowdhury, Debashish; Bohra, Vikram; Zutshi, Dhruv

doi:10.7860/jcdr/2013/6004.3512

Cited by 13 publications

(18 citation statements)

References 9 publications

(4 reference statements)

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“…The second important clinical feature is encephalopathy presents as change in behavior, confusion, ataxia, and memory loss, and exhibit upper motor neuron signs with increased muscle tone, deep tendon reflexes, and a positive Babinski sign. Exact pathogenesis not known but it is directly related to absolute eosinophil count and cerebral infarcts [5]. Our case had recurrent strokes as described which to begin with small artery strokes but as the disease progressed and eosinophil count increased became large artery strokes.…”

Section: Discussionmentioning

confidence: 99%

“…Initially strokes are small infarcts and borderzone. As the disease progresses, large artery strokes occur [5]. The second important clinical feature is encephalopathy presents as change in behavior, confusion, ataxia, and memory loss, and exhibit upper motor neuron signs with increased muscle tone, deep tendon reflexes, and a positive Babinski sign.…”

Section: Discussionmentioning

confidence: 99%

“…Absolute eosinophil count varied between 1500 to 3200 per cu.mm. HRCT chest suggestive of interstitial pneumonia like pattern Neurological manifestations include recurrent stroke, encephalopathy and peripheral sensory neuropathies [5]. Although the exact pathogenesis is not well known, eosinophil accumulation appears to have pathological consequences.…”

Section: Discussionmentioning

confidence: 99%

“…Patients often have non-specific symptoms like fatigue, myalgia, rash, low grade fever, cough and dysnoea [4]. Cardiac manifestation includes myocarditis, endocardial thrombi or endomyocardial fibrosis causing fatal restrictive cardiomyopathy [5]. Electrocardiogram may show non-specific and diffuse T-wave inversion.…”

Section: Discussionmentioning

confidence: 99%

“…Electrocardiogram may show non-specific and diffuse T-wave inversion. Echocardiogram and cardiac magnetic resonance imaging (MRI) are sensitive modalities for the detection of endomyocardial fibrosis and intracardiac thrombi [5]. Endomyocardial biopsy is the gold standard for diagnosis of endomyocardial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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A Tale of Recurrent Strokes due to Hypereosinophilic Syndrome

Raut¹,

Baheti²,

Raut³

et al. 2017

Med Clin Rev

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Recurrent strokes are a huge cause for concern as with each stroke there is further accumulation of disability. There are various vascular risk factors responsible for recurrent stroke. However patients without any traditional risk factor or recurrence of stroke despite of best medical management should be screened for rare but important causes for stroke recurrence, once such cause being hypereosiniophilia. Although rare, Hypereosinophilic syndrome (HES) can cause recurrent ischemic stroke. Underlying pathogenesis of hypereosinophilic syndrome could be heterogeneous but cardioembolism is the most common etiology for stroke. Also there is eosinophilia mediated cytotoxicity and release of proinflammatory cytokines contributing to tissue damage and multiple organ involvement and recurrent stroke. Here the authors describe a case of a middle aged gentleman presenting with recurrent strokes over a period of 3 years. He had other risk factors like dyslipidemia and despite of dual antiplatelet therapy and statins he continued to get recurrent strokes with increasing severity. Extensive laboratory workup ruled out other etiologies for the strokes and the only possible causative factor which could be identified was hypereosinophilia. Work up for hypereosiniophilia was negative. After starting steroids and normalisation of eosinophil count, there was no further recurrence of stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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