Vertigo and Parinaud's syndrome as presentation of Churg-Strauss syndrome

Intracranial complications are rare in Churg-Strauss syndrome (CSS). Cerebr al infarctions are the most common intracranial presentation, usually after the clinical diagnosis of CSS had been established. We present a case of v ertigo and Parinaud's syndrome as presentation of CSS in an asthmatic patie nt. Clinical examination revealed upward gaze limitation and bilateral midr iasis. A cranial computed tomography scan showed a small round hypoattenuat ing lesion located in the right thalamic-mesencephalic region, which was la ter confirmed by magnetic resonance imaging. There was eosinophilia of more than 50%, and p-ANCA were positive. After steroid treatment was started, v ertigo and diplopia resolved, and eosinophilia was reduced. After 24 months follow-up, the patient remains stable, with negative p-ANCA, taking 20 mg prednisone daily. Further magnetic resonance exams have shown findings that were similar to those of previous studies. This case shows how vertigo and transient diplopia may be the first symptoms of neurological complications in patients with CSS.