Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8571-8578
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8571
Hypereosinophilia with cerebral venous sinus thrombosis and intracerebral hemorrhage: A case report and review of the literature
Xiu-Hua Song, Tian Xu, Guo-Hua Zhao
Xiu-Hua Song, Tian Xu, Guo-Hua Zhao, Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
Author contributions: Song XH drafted the manuscript; Xu T collected the clinical data; Zhao GH revised the manuscript for intellectual content; all authors read and approved the final manuscript.
Supported by Zhejiang Research Center of Stroke Diagnosis and Treatment Technology, No. JBZX-202002; and Zhejiang Province Medical Science and Technology Project, No. 2020RC061 and No. 2018KY872.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Guo-Hua Zhao, MD, Director, Doctor, Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, No. 1 Shangcheng Avenue, Yiwu 322000, Zhejiang Province, China.
Received: May 17, 2021
Peer-review started: May 17, 2021
First decision: June 24, 2021
Revised: July 8, 2021
Accepted: July 28, 2021
Article in press: July 28, 2021
Published online: October 6, 2021

Hypereosinophilia (HE) is defined as a peripheral blood eosinophil count of > 1.5 × 109/L and may be associated with tissue damage. The clinical presentations of HE vary; however, myocardial fibrosis and thrombosis can threaten the lives of patients with sustained eosinophilia. Cerebral venous sinus thrombosis (CVST) in the setting of eosinophil-related diseases has seldom been reported. Here, we review the literature on HE with CVST to increase knowledge and encourage early diagnosis.


A previously healthy 41-year-old man was admitted to hospital with diarrhea and abdominal pain. He was treated with antibiotics for suspected acute colitis. Three days later, he experienced headache and vomiting. Brain computed tomography (CT) revealed thrombosis of the left jugular vein to the left transverse sinus vein. Platelet (PLT) count decreased to 60 × 1012/L, and absolute eosinophil count (AEC) increased to 2.41 × 109/L. He was treated with low-molecular-weight heparin. PLT count progressively decreased to 14 × 109/L, and we terminated anticoagulation and performed PLT transfusion. Six days after admission, he complained of a worsening headache. Brain CT revealed right temporal lobe and left centrum semiovale intracerebral hemorrhage, and AEC increased to 7.65 × 109/L. We used prednisolone for HE. The level of consciousness decreased, so emergency hematoma removal and decompressive craniectomy for right cerebral hemorrhage were performed. The patient was alert 2 d after surgery. He was treated with anticoagulation again 2 wk after surgery. Corticosteroids were gradually tapered without any symptomatic recurrence or abnormal laboratory findings.


HE can induce CVST, and we need to focus on eosinophil counts in patients with CVST.

Keywords: Cerebral venous sinus thrombosis, Intracerebral hemorrhage, Hypereosinophilia, Hypereosinophilic syndrome, Thrombocytopenia, Colitis, Case report

Core Tip: Thromboembolism is a rare but serious complication of hypereosinophilia (HE). We report a 41-year-old man who presented with colitis, cerebral venous sinus thrombosis (CVST), and intracerebral hemorrhage caused by HE. Blood eosinophil count decreased quickly after corticosteroid therapy, and CVST caused headache, which improved after anticoagulation therapy. Good clinical outcomes were observed during a 6-mo follow-up period. We conclude that HE can induce CVST, and we need to focus on eosinophil counts in patients with CVST. Corticosteroids are a useful first-line therapy for platelet-derived growth factor receptor A/B-negative HE.