Meningovascular Syphilis: A Vascular Syndrome with Typical Features? (original) (raw)
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Multifocal strokes in a 56-year-old man with HIV infection
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015
A 56-year-old man presented with a oneday history of vomiting, vertigo and blurred vision in both eyes preceded by a three-week history of fever, night sweats and a 5-kg weight loss. He had no recent history of travel or contact with sick people. His past medical history was notable for untreated HIV infection diagnosed eight months previously, after treatment for presumed Pneumocystis jirovecii pneumonia. At that time, his CD4 count was 0.072 × 10 9 /L. He was immune to hepatitis B virus infection secondary to a previous natural infection, and he had remote idiopathic retinal vasculitis. He had had chickenpox as a child. There was no history of hypertension, diabetes mellitus, smoking, dyslipidemia, atrial fibrillation or cardiac disease. He denied intravenous drug use. On examination, the patient was afebrile, his blood pressure was 133/83 mm Hg, and his heart rate was 57 beats/min and regular. He was somnolent but rousable and answered questions appropriately. Findings on cardiovascular, respiratory and abdominal examinations were normal. Neurologic examination showed bilateral eye deviation to the right as well as horizontal, vertical and torsional nystagmus in primary position, which worsened with rightward gaze. There was right-sided miosis but no ptosis. Speech and swallowing were normal. Muscle tone, power and reflexes were normal. There was decreased sensation to pinprick in the right cheek and the left arm and leg. The patient had marked ataxia in his right arm and leg (appendicular ataxia). Dermatologic examination revealed several crusted skin lesions distributed over his body, with a single vesicle overlying his right zygoma. There were no peripheral findings of infective endocarditis. The patient's leukocyte count was 2.4 (normal 4.0-11.0) × 10 9 /L, hemoglobin A 1C concentration 6% (normal 4%-6%) and low-density lipoprotein cholesterol 2.76 mmol/L. Blood cultures for bacteria were negative. Tests of the patient's serum were negative for syphilis and cryptococcal antigen. The erythrocyte sedimentation rate was 41 (normal 0-10) mm/h. Magnetic resonance imaging of the brain showed small acute infarcts in the left frontal cortex and deep white matter (the territory supplied by the left middle cerebral artery) and in the right lateral medulla and right cerebellar hemisphere (the territory supplied by the right posterior inferior cerebellar artery) (Figure 1). Computed tomography (CT) angiography showed smooth narrowing of the left posterior cerebral artery with What is your call?
Cureus, 2021
Moyamoya syndrome is a chronic and progressive narrowing of the arteries in the brain caused by different mechanisms than the genetic mutation that leads to moyamoya disease. It is characterized by the narrowing and/or closing of the carotid artery with a collateral circulation development around the blocked vessels to compensate for the ischemia. In this report, we present a unique case of moyamoya syndrome that developed over the course of a few months in a patient with new-onset strokes and seizures in the setting of late diagnosis of neurosyphilis and acquired immunodeficiency syndrome (AIDS). To our knowledge, moyamoya syndrome secondary to coinfection with AIDS and meningovascular neurosyphilis has only been reported once in the literature.
Primary Angiitis of the Central Nervous System
Archives of Neurology, 2009
Primary angiitis of the central nervous system (PACNS) is a rare idiopathic disorder with recurrent vasculitis restricted to the central nervous system (CNS) and involves the small-sized (and at times the medium-sized) blood vessels(1,2). The typical clinical manifestations include multifocal strokes or encephalopathy, often associated with severe headache(3). There are very few pediatric cases with PACNS reported in the literature. The diagnosis of PACNS is mainly based on the clinical features, demonstration of angiitis on angiography or biopsy and exclusion of secondary causes of angiitis. A high index of suspicion is necessary for the diagnosis(4). Though the prognosis is generally poor, use of steroids and immunosuppressive therapy have been useful to achieve successful remission in many patients(1,4-7). We report a case of PACNS in a child with a brief review of literature. Case Report An eleven-year-old girl born of a third degree consanguineous marriage was brought with the complaints of fever and headache for two months and two episodes of left focal convulsions four days prior to admission. Her sensorium and vital parameters were normal and the general examination was noncontributory. CNS examination was normal except for papilledema on fundoscopic examination. After 12 hours of admission, she had one more episode of left focal convulsion associated with altered sensorium. Her sensorium showed a waxing and waning course over the next seven days. A computed tomographic (CT) scan of the brain after the first convulsion had shown a left parietal venous infarct (Fig. 1). A repeat CT scan after admission (after the third convulsion) revealed bilateral white matter changes with bilateral frontal infarcts (Fig.2). Complete hemogram, chest radiograph, sickling test, renal and liver function tests, prothrombin time and partial thromboplastin time were normal. Urine cyanide-nitroprusside test for homocystinuria was negative. Serological tests for human immunodeficiency virus and hepatitis B virus were negative. A cerebrospinal fluid (CSF) examination done on third day after admission revealed seven red blood cells, three lymphocytes and proteins of 70 mg/dl with normal CSF sugar.
Unusual Intracranial Manifestation of Infective Endocarditis
The Open Neuroimaging Journal, 2021
Objective: The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment. Methods: A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done. Result: The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches. Conclusion: Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology...
Brain Pathology 22 (2012) 729–732
A 49-year-old man presented with fever and altered mental status. He had a complex prior medical history notable for type I diabetes mellitus with end-stage renal disease and peripheral vascular disease. Eight years prior to admission he underwent pancreatic and renal transplantation secondary to diabetes. The renal transplantation procedure was initially complicated by intra-operative myocardial infarction, and subsequently by acute and chronic allograft rejection. Consequently, the patient had been on long-term immunosuppressive therapy. He also suffered from chronic atrial fibrillation requiring warfarin and had undergone cardiac valve replacement one year earlier.
Claude's Syndrome associated with Neurosyphilis: Case Report
SVOA Neurology, 2021
The alterations of the midbrain represent a great clinical challenge due to their anatomical location, it confers the passage of multiple tracts between the cerebral cortex and other subcortical structures such as cerebellum, pons and bulb, responsible for sensory-motor and autonomic control, which implies the difficult comprehension of clinical manifestations in the primary medical context, which delays the diagnosis and an adequate therapeutic approach. This article aims to make a clinical anatomical radiological correlation of the dorso-medial syndrome on the midbrain under the context of a patient diagnosed by meningovascular syphilis. The midbrain is the most cephalic portion of the brainstem, extending from the pontomesencephalic junction to join the diencephalon. Its anterior limits are given by the crus cerebri and the interpeduncular fossa, while at a posterior level it is characterized by the presence of the superior and inferior colliculi (1). It contains important fibers that allow the transmission of information between the cerebral cortex, the cerebellum, the pons and the medulla, for which it participates in the processing of auditory and visual information, and movement control (2). Therefore, it is important that the clinician is familiar with the external and internal configuration of the midbrain to facilitate the location of structures that can be injured and identified in neuroimaging techniques. At a clinical level, lesions of the midbrain, as in all structures of the brainstem, can be identified by the presence of cross-over syndromes, where ipsilateral cranial nerve alterations are evidenced that originate at this level associated with con-tralateral sensory or motor alterations (3). According to the literature reviewed, the main etiologies to be identified in brain stem syndromes are vascular, infectious, compressive, demyelinating and traumatic lesions, which give rise to syndromes such as Weber, Benedikt, Parinaud, Nothnagel and finally Claude, as the case may be. which will be described below (Semiological description of the midbrain syndromes-See table 1). Case Report: A 45-year-old man living on the street who consulted for a sudden onset of symptoms characterized by hemiparesis associated with dysdiadochokinesis and left hemiataxia with horizontal diplopia. Due to the limitation of adduction of the right eye, on admission with TA 100/60, fasting blood glucose 89 mg / dl, negative urine toxic tests, skull CT showing greater atrophy than expected for age, with no other detectable lesions, lipid profile within normality and a serology by RPR technique: POSITIVE (1: 256 DILS), FTA ABS: positive, HIV: negative.