Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of multiple cerebral hemorrhage caused by sudden increase of eosinophil in a patient with eosinophilic granulomatosis with polyangiitis

Yumi Yamada, M.D.1), Shoichiro Ando, M.D.1), Yoshitaka Umeda, M.D.1), Maiko Umeda, M.D.1), Mutsuo Oyake, M.D., Ph.D.1) and Nobuya Fujita, M.D., Ph.D.1)

1)Department of Neurology, Nagaoka Red Cross Hospital

A 42-year-old woman with bronchial asthma was admitted to our hospital due to sensory dominant mononeuritis multiplex lasting for more than 6 months. At that time, her eosinophil count was 761/µl and her sural nerve biopsy showed no findings suggestive of vasculitis. Four months later, she experienced sudden convulsions and right hemiparesis due to left lobular parietal subcortical hemorrhage, when her eosinophil count was elevated to 3,257/µl. Numerous microbleeds and small infarctions were also detected in the intracerebral areas of different regions with MRI. Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis of the small vessels, commonly affecting the peripheral nerves. Subarachnoid hemorrhage in patients with EGPA is extremely rare. Steep elevation of the eosinophil count may release certain cytokines, causing cerebral hemorrhage.
Full Text of this Article in Japanese PDF (683K)

(CLINICA NEUROL, 58: 565|569, 2018)
key words: eosinophilic granulomatosis with polyangiitis, eosinophilia, multiple cerebral hemorrhage, multiple cerebral infarction

(Received: 21-May-18)