Central nervous system involvement in the eosinophilia-myalgia syndrome
J. Lynn, K. W. Rammohan, R. A. Bornstein and J. T. Kissel
Department of Neurology, Ohio State University College of Medicine, Columbus 43210.
A patient with eosinophilia-myalgia syndrome developed progressive central
nervosa system involvement that did not improve despite discontinuation of
L-tryptophan therapy. Neurologic impairment was manifested initially by
spastic monoparesis, which was improved by treatment with
methyl-prednisolone and hydroxyurea. Recurrence of weakness was accompanied
by gait ataxia, dysphagia, and complaints of a gradual decline in memory
and concentration. Neuropsychological testing identified a broad pattern of
cognitive deficits suggestive of a subcortical dementia, and magnetic
resonance imaging demonstrated multiple high-signal lesions in the white
matter. Cognitive deficits appear to be underrecognized in patients with
the eosinophilia-myalgia syndrome. The response of our patient's initial
symptoms to corticosteroid therapy suggests a possible role for autoimmune
mechanisms in the pathogenesis of central nervous system involvement in the
eosinophilia-myalgia syndrome. Neuropsychological evaluation should be
performed in patients with cognitive complaints to delineate the full
spectrum of central nervous system impairment associated with the
eosinophilia-myalgia syndrome.
