Central nervous system involvement in the eosinophilia-myalgia syndrome.
A patient with eosinophilia-myalgia syndrome developed progressive central nervosa system involvement that did not improve despite discontinuation of L-tryptophan therapy. Neurologic impairment was manifested initially by spastic monoparesis, which was improved by treatment with methyl-prednisolone and hydroxyurea. Recurrence of weakness was accompanied by gait ataxia, dysphagia, and complaints of a gradual decline in memory and concentration. Neuropsychological testing identified a broad pattern of cognitive deficits suggestive of a subcortical dementia, and magnetic resonance imaging demonstrated multiple high-signal lesions in the white matter. Cognitive deficits appear to be underrecognized in patients with the eosinophilia-myalgia syndrome. The response of our patient's initial symptoms to corticosteroid therapy suggests a possible role for autoimmune mechanisms in the pathogenesis of central nervous system involvement in the eosinophilia-myalgia syndrome. Neuropsychological evaluation should be performed in patients with cognitive complaints to delineate the full spectrum of central nervous system impairment associated with the eosinophilia-myalgia syndrome.
Lynn
J
J
Department of Neurology, Ohio State University College of Medicine, Columbus 43210.
Rammohan
K W
KW
Bornstein
R A
RA
Kissel
J T
JT
D002493:Central Nervous System Diseases / Q000473:pathology / Q000523:psychology*; D016603:Eosinophilia-Myalgia Syndrome / Q000378:metabolism / Q000473:pathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D014364:Tryptophan / Q000378:metabolism; D014706:Verbal Learning
D014364:Tryptophan