Diffusion-weighted imaging of encephalopathy related to idiopathic hypereosinophilic syndrome.
Encephalopathy related to idiopathic hypereosinophilic syndrome (HES encephalopathy) is a rare (but well-documented) syndrome. Magnetic resonance imaging (MRI) findings of HES encephalopathy, particularly diffusion-weighted images (DWI) findings, have not been reported. We report a case of HES encephalopathy in a 79-year-old male presenting with a focal neurological deficit and cognitive function disorders. Eosinophil number was >20,000/mm(3). Initial DWI revealed multiple high-signal lesions that were clearer than on T2-weighted images. After corticosteroid therapy, symptoms improved and MRI-identified lesions decreased. This is the first report demonstrating DWI findings of HES encephalopathy. We suggest that lesions identified on MRI may be related to a combination of demyelination, inflammation and/or even small-vessel infarction due to local intimal lesions and clotting, secondary to eosinophilic toxicity. Investigation using DWI should therefore be done in patients with HES encephalopathy even if T2-weighted images are normal.
Kono
Yu
Y
Department of Neurology, Fuji City Central Hospital, 50 Takashima, Fuji, Shizuoka 417-8567, Japan. yu1028@jikei.ac.jp
Itoh
Yasuhiko
Y
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D008297:Male; D011859:Radiography; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones