Cerebral arteriolar thromboembolism in idiopathic hypereosinophilic syndrome.
OBJECTIVE
To describe imaging findings as well as postmortem brain and cardiac pathology in a patient with fulminant idiopathic hypereosinophilic syndrome.


METHODS
Case report.


METHODS
University hospital.


METHODS
A 48-year-old right-handed man with hypereosinophilia, rapidly progressive encephalopathy, and focal neurological deficits who died 22 days after presentation.


METHODS
Physical examination, radiologic, and neuropathologic examination results.


RESULTS
Imaging of the brain revealed bihemispheric ischemic changes in and beyond the watershed distributions. Pathology review demonstrated mural cardiac thrombus that likely caused cardioembolism as well as diffuse microangiopathy despite resolution of the hypereosinophilia.


CONCLUSIONS
Timely recognition of idiopathic hypereosinophilic syndrome may enable aggressive treatment prior to widespread cardioembolism and degranulation that result in devastating cerebrovascular complications.
Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA. mikayel-grigoryan@uiowa.edu
Mikayel
M
Grigoryan
Scott D
SD
Geisler
Erik K
EK
St Louis
Gary L
GL
Baumbach
Patricia H
PH
Davis
D020771:Anterior Cerebral Artery / Q000473:pathology; D001160:Arterioles / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D001921:Brain / Q000473:pathology; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D017548:Echocardiography, Transesophageal; D004699:Endocardium / Q000473:pathology; D017809:Fatal Outcome; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D007091:Image Processing, Computer-Assisted; D020243:Infarction, Anterior Cerebral Artery / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D014057:Tomography, X-Ray Computed