Cerebral infarcts in the setting of eosinophilia: three cases and a discussion.

OBJECTIVE To describe 3 cases of stroke associated with hypereosinophilic syndrome and discuss the pathogenesis of such strokes. DESIGN Retrospective medical record review. SETTING University hospital. PARTICIPANTS Three patients who had strokes temporally correlating with eosinophilia with no other obvious causes of stroke. INTERVENTION Retrospective review of the hospital course, laboratory data, imaging, treatment, and outcome. RESULTS All 3 patients had multiple strokes in both hemispheres. Two patients with modest eosinophilia that was controlled quickly had infarcts mostly in arterial border zones and had good outcomes. The third patient with severe and more refractory eosinophilia had a poor outcome. CONCLUSIONS Cardiac emboli and direct eosinophil toxicity contribute to strokes in hypereosinophilic syndrome. Prognosis is variable with use of anticoagulation and antiplatelet agents but rapid lowering of the eosinophil count results in a better outcome.

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