Literature reviews of stroke with hypereosinophilic syndrome

Abstract

Hypereosinophilic syndrome (HES) is defined by persistently elevated blood eosinophil levels and is associated with evidence of organ damage. Cardiovascular involvement in HES is most commonly associated with Loffler endocarditis (cardiac HES). Cardiac HES is typically characterized by progressive subendocardial fibrosis with overlying mural thrombus formation, leading to restrictive dysfunction of the left ventricle. The thrombus from cardiac HES could result in cardiogenic stroke; however, most of the stroke cases with HES were not associated with huge thromboembolism rather multiple infarcts in the watershed area. The major clinical features of 97 previously reported cases of stroke with HES are as follows: the median age was 52 years, of which 61 (63%) were men; the initial presenting symptoms were neurological (73%), followed by headache (16%), respiratory symptoms (9%), and visual symptoms (9%). Almost half of the cases were diagnosed with cardiac HES. The characteristics of cardiac findings were mural thrombi, endomyocardial fibrosis, and a restrictive pattern of heart failure. Cerebral findings revealed 78 cases (80%) were described as multiple infarctions and 55 cases (57 %) were involved with watershed areas, whereas 11 cases (11％) were described as embolic stroke for one proximal large-vessel occlusion. Regarding treatment, 71 (73%), 28 (29%), and 16 (16%) patients were treated with steroids, anticoagulants, and antiplatelets, respectively. The overall mortality and recovery rates were 11% and 89%, respectively. Physicians should know most cases of stroke with HES are characterized by multiple infarctions in the watershed area, and cardiac HES is not always associated with stroke.

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

“…8,78 A small number of case reports and case series of LV thrombus have been reported in patients with other forms of DCM, including hypertrophic cardiomyopathy, chemotherapy-related cardiomyopathy, cardiac amyloidosis, cardiomyopathy attributable to Chagas disease, and eosinophilic myocarditis. [31][32][33][34][35] No prospective observational studies or randomized clinical trials have evaluated the impact of anticoagulation in these patients for the primary prevention of LV thrombus.…”

A prediction model for left ventricular thrombus persistence/recurrence: based on a prospective study and a retrospective study

“…Based on Virchow's triad of thrombogenesis, three factors include stasis attributable to reduced ventricular function, endocardial injury, and inflammation/hypercoagulability. The interaction between these mechanisms and thrombus outcome, however, is not always easy to clarify [ 20 , 21 ]. According to our finding, the rate of thrombus persistence/recurrence at 3 months differed among patients with ICM, DCM, and other cardiovascular disorders while it was unreliable to conclude whether DCM or other diseases patients had a higher likelihood of thrombus persistence than those with ICM.…”

Imaging patterns of cerebral ischemia in hypereosinophilic syndrome: case report and systematic review

“…The most important causes for ischemic stroke include cardioembolism, large vessel disease, and small vessel disease, but there are many additional less frequent causes which need to be investigated when stroke etiology remains unclear. Cerebral ischemia is a well-known complication of hypereosinophilic syndromes (HES) [ 1 , 2 ]. HES are defined as clinical manifestations attributed to end-organ dysfunction associated with peripheral eosinophilia, which may occur in the setting of several conditions, such as parasitic infections, drug hypersensitivity, eosinophilic granulomatosis with polyangiitis, and other autoimmune diseases [ 3 ].…”