A Tale of Recurrent Strokes due to Hypereosinophilic Syndrome

Recurrent strokes are a huge cause for concern as with each stroke there is further accumulation of disability. There are various vascular risk factors responsible for recurrent stroke. However patients without any traditional risk factor or recurrence of stroke despite of best medical management should be screened for rare but important causes for stroke recurrence, once such cause being hypereosiniophilia. Although rare, Hypereosinophilic syndrome (HES) can cause recurrent ischemic stroke. Underlying pathogenesis of hypereosinophilic syndrome could be heterogeneous but cardioembolism is the most common etiology for stroke. Also there is eosinophilia mediated cytotoxicity and release of proinflammatory cytokines contributing to tissue damage and multiple organ involvement and recurrent stroke. Here the authors describe a case of a middle aged gentleman presenting with recurrent strokes over a period of 3 years. He had other risk factors like dyslipidemia and despite of dual antiplatelet therapy and statins he continued to get recurrent strokes with increasing severity. Extensive laboratory workup ruled out other etiologies for the strokes and the only possible causative factor which could be identified was hypereosinophilia. Work up for hypereosiniophilia was negative. After starting steroids and normalisation of eosinophil count, there was no further recurrence of stroke.