NEUROTRICHINOSIS - A CEREBROVASCULAR-DISEASE ASSOCIATED WITH MYOCARDIAL INJURY AND HYPEREOSINOPHILIA

The clinical features, brain computerized tomography (CT) scans and ca rdiological findings of nine patients with neurotrichinosis are review ed. Neurological signs consisted of encephalopathy and focal deficits with small hypodensities in the cortex and white matter, detected by t he CT scans. Various cardiovascular events were also observed in eight out of nine patients. They were usually concomitant with neurological symptoms and mainly consisted of myocardial injury as assessed by ele ctrocardiographic and plasma creatine phosphokinase (CPK)-MB isoenzyme changes. The cardio-neurological syndrome developed early in the cour se of the disease at a time of marked hypereosinophilia and the percen tage of patients with eosinophilia greater-than-or-equal-to 4000 mm3 w as significantly higher in the patients with neurological dysfunction than in those without neurological signs. We selected the following cr iteria to describe the distinctive cardio-neurological syndrome relate d to trichinosis: (i) early onset of neurological symptoms (within a f ew days) after the first general symptoms; (ii) central nervous system involvement consisting of both diffuse encephalopathy and focal neuro logical deficits, usually of simultaneous onset; (iii) concomitant acu te myocardial injury and/or infarction; (iv) marked hypereosinophilia (greater-than-or-equal-to 4000/mm3) at time of first cardio-neurologic al events; (v) brain CT scan showing small hypodensities in the hemisp heric white matter or cortex. Post-mortem examination of one patient r evealed ischaemic lesions with multiple arteriolar microthrombi in the brain and myocardium. This was consistent with the brain CT scan and electrocardiographic data and suggested that neurotrichinosis is an ex pression of a multi-organ disorder associated with hypereosinophilia, that is characterized in most patients by simultaneous neurological an d myocardial manifestations basically related to ischaemia.