1. FIP1L1-PDGFRA-Associated Hypereosinophilic Syndrome as a Treatable Cause of Watershed Infarction.
- Author
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Tennenbaum J, Groh M, Venditti L, Campos-Gazeau F, Chalayer E, De Broucker T, Hamidou M, Hunault M, Lyoubi A, Meunier R, Muron T, Sène D, Slama B, Guidoux C, Lefèvre G, Kahn JE, Denier C, and Rohmer J
- Subjects
- Adult, Brain diagnostic imaging, Cerebral Infarction diagnostic imaging, Coronary Thrombosis complications, Female, Follow-Up Studies, Humans, Hypereosinophilic Syndrome diagnostic imaging, Imatinib Mesylate therapeutic use, Ischemic Stroke diagnostic imaging, Male, Middle Aged, Recurrence, Retrospective Studies, Treatment Outcome, Cerebral Infarction etiology, Cerebral Infarction therapy, Hypereosinophilic Syndrome complications, Hypereosinophilic Syndrome therapy, Ischemic Stroke genetics, Ischemic Stroke therapy, Oncogene Proteins, Fusion genetics, Receptor, Platelet-Derived Growth Factor alpha genetics, mRNA Cleavage and Polyadenylation Factors genetics
- Abstract
Background and Purpose: Ischemic stroke has been reported in various conditions associated with eosinophilia. FIP1L1-PDGFRA fusion ([Fip1-like 1-platelet-derived growth factor receptor alpha]; F/P) leads to the proliferation of the eosinophilic lineage and thus to a clonal hypereosinophilic syndrome that is highly responsive to imatinib., Methods: We previously reported on a nationwide retrospective study of 151 patients with F/P-associated clonal hypereosinophilic syndrome. Patients from this cohort with a clinical history of ischemic stroke (as well as 2 additional cases) were further analyzed to better define their clinical picture and outcomes., Results: Sixteen male patients (median age, 51 [43–59] years) with low-to-intermediate cardiovascular risk were included. Median National Institutes of Health Stroke Scale was 4 (range, 1–6). Most cerebral imaging disclosed multiple bilateral infarctions of watershed distribution (69%). Despite frequent cardiac involvement (50%), cardiac thrombus was evidenced in a single patient and, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment), 62.5% of strokes were presumably of undetermined etiology. Among the 15 patients treated with imatinib, and after a median follow-up of 4.5 years, stroke recurred in only 3 patients (consisting of either cardio embolic or hemorrhagic events, unrelated to the first episode)., Conclusions: F/P+ clonal hypereosinophilic syndrome is a diagnosis to consider in patients with unexplained ischemic stroke and hypereosinophilia (especially in the setting of multiple cortical borderzone distribution) and warrants prompt initiation of imatinib.
- Published
- 2021
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