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Eosinophilic vasculitis in an isolated central nervous system distribution
  1. R B Sommerville1,
  2. J M Noble2,
  3. J P Vonsattel3,
  4. R Delapaz4,
  5. C B Wright2
  1. 1The Neurological Institute of New York, College of Physicians and Surgeons of Columbia University, New York, NY, USA
  2. 2Department of Neurology, The Neurological Institute of New York, New York, NY, USA
  3. 3Department of Pathology, The Neurological Institute of New York, New York, NY, USA
  4. 4Department of Radiology, The Neurological Institute of New York, New York, NY, USA
  1. Correspondence to:
 C B Wright
 Department of Neurology, The Neurological Institute of New York, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032, USA;cbw7{at}columbia.edu

Abstract

Background: Eosinophilic vasculitis has been described as part of the Churg–Strauss syndrome, but affects the central nervous system (CNS) in <10% of cases; presentation in an isolated CNS distribution is rare. We present a case of eosinophilic vasculitis isolated to the CNS.

Case report: A 39-year-old woman with a history of migraine without aura presented to an institution (located in the borough of Queens, New York, USA; no academic affiliation) in an acute confusional state with concurrent headache and left-sided weakness and numbness. Laboratory evaluation showed increased cerebrospinal fluid (CSF) protein level, but an otherwise unremarkable serological investigation. Magnetic resonance imaging showed bifrontal polar gyral-enhancing brain lesions. Her symptoms resolved over 2 weeks without residual deficit. After 18 months, later the patient presented with similar symptoms and neuroradiological findings involving territories different from those in her first episode. Again, the CSF protein level was high. She had a raised C reactive protein level and erythrocyte sedimentation rate. Brain biopsy showed transmural, predominantly eosinophilic, inflammatory infiltrates of medium-sized leptomeningeal arteries without granulomas. She improved, without recurrence, when treated with a prolonged course of corticosteroids.

Conclusions: To our knowledge, this is the first case of non-granulomatous eosinophilic vasculitis isolated to the CNS. No aetiology for this patient’s primary CNS eosinophilic vasculitis has yet been identified. Spontaneous resolution and recurrence of her syndrome is an unusual feature of the typical CNS vasculitis and may suggest an environmental epitope with immune reaction as the cause.

  • CSF, cerebrospinal fluid
  • CNS, central nervous system
  • HSV, herpes simplex virus
  • MRI, magnetic resonance imaging

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Footnotes

  • Competing interests: None declared.

  • Published Online First 22 August 2006

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