FIP1L1-PDGFRA-Positive Hypereosinophilia Presenting with Bilateral Extracranial Carotid Artery Aneurysms

• Published in: World neurosurgery 2020, Vol.139, p.419-422
• Main Authors: Moalong, Kevin Michael Cachapero, Diestro, Jose Danilo Bengzon, Espiritu, Adrian Isidoro, Lucero, Josephine Anne Cuevas, de la Cruz, Aeron Patrick Roy Ledesma, Valencia, Jeffrey Matubis, Chua, Enrique Melarin, Cenina, Alvin Rae Francisco, Spears, Julian, San Jose, Maria Cristina Zarsadias
• Format: Report
• Language: English
• ISSN: 1878-8769
• DOI: 10.1016/j.wneu.2020.04.119

OBJECTIVETo describe a case of an adult female Filipino with hypereosinophilia and bilateral carotid artery aneurysms who subsequently developed bilateral cerebral hemisphere strokes following aneurysm stenting. CASE DESCRIPTIONA 57-year-old female patient with persistent hypereosinophilia presented with progressively enlarging bilateral neck masses, revealed to be carotid artery aneurysms on computed tomography angiography. Following surgical exploration, she later developed right-sided hemiplegia, aphasia, and right hemianopia. Cranial computed tomography revealed infarcts on both middle cerebral artery territories. Bone marrow biopsy and fluorescent in situ hybridization revealed findings suggestive of hypereosinophilic syndrome. She was started on standard aspirin and statin therapy and was discharged sixteen days after the procedure. Partial improvement of neurologic deficits was noted two months later on follow up. Chemotherapy with imatinib was initiated. CONCLUSIONSThis patient's prothrombotic state from FIP1L1-PDGFRA-positive hypereosinophilia may have led to large carotid artery aneurysm formation and intramural thrombosis. This case demonstrates a possible and heretofore undocumented neurovascular sequela of hypereosinophilic syndrome.