Abstract Details

Title A Unique Presentation of Hypereosinophilic Myocarditis Induced Bilateral Thromboembolic Ischemic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-010

Objective NA

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.

Design/Methods NA

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.

Authors/Disclosures
Alisha Qaiser, MD PRESENTER	Dr. Qaiser has nothing to disclose.
Anna McDowell-Moody, MD	Mrs. McDowell-Moody has nothing to disclose.
Taylor R. Anderson, MD (Trinity Health Muskegon)	Dr. Anderson has nothing to disclose.
Muhammad Farooq, MD (Neuroscience Program,Saint Mary'S Health)	Dr. Farooq has nothing to disclose.

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