A Unique Presentation of Hypereosinophilic Myocarditis Induced Bilateral Thromboembolic Ischemic Strokes
Alisha Qaiser1, Anna McDowell-Moody3, Taylor Anderson4, Muhammad Farooq2
1Neurology, 2Vascular Neurology, Trinity Health Grand Rapids, 3Michigan State University College of Human Medicine, 4Neurology, Trinity Health Muskegon
Background:
Myocarditis is an inflammatory process affecting the heart due to many causes such as infective/inflammatory diseases. It typically presents with signs of heart failure but may be limited to chest pain. However, our patient did not have any classic signs of myocarditis. He presented with acute onset of confusion and was later found to have bilateral ischemic strokes appearing cardioembolic secondary to myocarditis.
Results:
A 72-year-old male with recent NSTEMI presented to the emergency department as a stroke-alert. His last known well was 12 hours prior to presentation. On arrival, his blood pressure was 125/110. Neurologic exam showed disorientation to self and location, and was otherwise benign. Initial head CT and CT angiogram of the head and neck showed no abnormalities. MRI brain demonstrated bihemispheric multifocal punctate areas of restricted diffusion. TTE and TEE were both unremarkable. 2-hour electroencephalogram monitoring was normal. He had elevated troponin 9,849 ng/L which was thought to be secondary to his recent NSTEMI. CBC revealed mild leukocytosis and relative eosinophilia of 30%. He was discharged on aspirin and statin therapy. He returned the following day with new onset right arm weakness. Repeat MRI brain showed numerous new bilateral supra and infratentorial areas of restricted diffusion. Repeat TEE demonstrated concentric hypertrophy with a speckled appearance, which raised suspicion for an infiltrative cardiomyopathy. Given concern for myocarditis, coxsackie B virus antibodies were checked and found to be positive. On follow up in the neurology clinic, his deficits were improving however was not back to baseline.
Conclusions:
This case of cardioembolic stroke due to a virally-induced hypereosinophilic myocarditis illustrates a rare clinical finding. The variability seen in clinical presentation adds to its difficulty in diagnosis and management. Ultimately, in hypereosinophilic patients presenting with end-organ dysfunction like cerebrovascular disease, myocarditis should be suspected.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.