Idiopathic hypereosinophilia syndrome with loeffler endocarditis, embolic cerebral infarction, and left hydranencephaly: a case report.
OBJECTIVE
Idiopathic hypereosinophilia syndrome (iHES) is classically defined as prolonged peripheral eosinophilia and multiple organ involvement. The involvement of the heart can lead to intraventricular thrombus because of infiltration of the endomyocardium by eosinophils. Cerebral infarction has been ascribed to thromboembolic events originating from intraventricular thrombus.


METHODS
A 67 year-old woman with hypereosinophilia for 6 months presented acute weakness of the right limbs. Left hydranencephaly and absence of the left internal carotid artery were found on brain computed tomography. Brain magnetic resonance imaging (MRI) showed multiple infarctions at bilateral hemispheres. An intraventricular thrombus was detected both in transesophageal echocardiography and in heart MRI. Hypereosinophilia responded well to steroid use and warfarin was used for stroke prevention.


CONCLUSIONS
Complete evaluation of systemic involvement in iHES is mandatory and early intervention may prevent deterioration of this disease. Both cardiogenic embolism and endothelial damage related to circulating eosinophils may contribute to the occurrence of stroke in this patient.
Lin
Chih-Hsiang
CH
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chang
Wen-Neng
WN
Chua
Sarah
S
Ko
Sheung-Fat
SF
Shih
Lee-Yung
LY
Huang
Chi-Wei
CW
Chang
Chiung-Chih
CC
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D006832:Hydranencephaly / Q000150:complications* / Q000175:diagnosis; D017681:Hypereosinophilic Syndrome / Q000150:complications* / Q000175:diagnosis; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods