Multiple strokes and cerebral microangiopathy in a patient with Churg-Strauss syndrome

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease that mainly affects the lungs and skin. It is considered to be a small and medium-vessel vasculitis. Although neurologic manifestations of EGPA are reported, usually consisting of peripheral neuropathy, central nervous system manifestations are quite rare, those described being cerebral infarctions or hemorrhages.

 We present the case of a 79-year-old woman diagnosed in 2016 with EGPA, being treated with Prednisone and Azathioprine, who presented to the Neurological Emergency Department with right hemiplegia, dysmetria in the left arm and right hemi-hypoesthesia. CT (computed tomography) and MRI (Magnetic resonance imaging) findings on admission described lacunar strokes. The patient presented with low creatinine clearance on admission (positive for chronic renal disease), grade III hypertension, ischemic cardiomyopathy and right calf deep vein thrombosis. The patient was started on neuroprotective and neurotrophic treatment associated with parenteral hydration, anticoagulant and hypotensive drugs .  The patient’s symptoms partially improved, with possibility of independently maintaining a sitting position and upright stance with unilateral sustenance at discharge.

Patients suffering from vasculitides must be carefully observed in order to prevent or treat complications that may emerge.