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Multiple Thromboembolic Cerebral Infarctions from the Aorta in a Patient with Churg-Strauss Syndrome

Hideo Okada1

  • 1Department of Neurological Surgery, Wakayama Rosai Hospital, Wakayama, Japan.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|December 21, 2016
PubMed

Insights

Churg-Strauss syndrome (CSS) rarely causes ischemic stroke. This case highlights aortic thrombus embolism as a potential cause, distinct from cerebral vasculitis, in CSS patients experiencing cerebral infarction.

Area of Science:

  • Neurology
  • Cardiology
  • Rheumatology

Background:

  • Churg-Strauss syndrome (CSS), a rare eosinophilic granulomatosis with polyangiitis, can present with neurological complications.
  • Ischemic stroke is an uncommon manifestation of CSS, with unclear underlying mechanisms.
  • Cerebral vasculitis is a recognized cause of stroke in CSS patients.

Observation:

  • A 39-year-old male with CSS experienced multiple cerebral infarctions.
  • Clinical diagnosis of CSS was supported by eosinophilia, asthma, sinusitis, pulmonary infiltrates, and gastric biopsy findings.
  • Cerebral angiography revealed no arterial stenosis, but transesophageal echocardiography identified an aortic wall thrombus.

Findings:

  • The aortic thrombus was identified as the source of cerebral embolism.
  • The patient presented with hemiparesis and visual disturbances.
  • The aortic thrombus resolved spontaneously within three months.

Implications:

  • This case report is the first to describe cerebral infarction due to aortogenic thromboembolism in a CSS patient.
  • It suggests that embolism from the cardiovascular system, specifically the aorta, should be considered in CSS-related strokes.
  • This broadens the differential diagnosis for ischemic stroke in patients with Churg-Strauss syndrome beyond cerebral vasculitis.
Abstract

Keywords:
Churg–Strauss syndromeaortaembolismeosinophiliavasculitis

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