Basilar Artery Aneurysm in a Woman With Syphilis (original) (raw)
Case report. Neurosyphilis Masquerading as Stroke in an 84-year-old
The Journal of Critical Care Medicine, 2017
The case of an 84 years old woman with uncharacteristic neurologic and cognitive symptoms, suspected of ischemic stroke is presented. Following an extensive assessment in the departments of neurology and internal medicine, the unusual aetiology of stroke was identified as meningovascular neurosyphilis. The patient fully recovered after antibiotic therapy. To our knowledge, this the eldest patient with tertiary neurosyphilis reported in the literature.
Case of Neurosyphilis Presented as Recurrent Stroke
2015
The name Syphilis is derived from the Greek word “Syphilos” meaning crippled or maimed. Syphilis is usually a sexually transmitted infection characterized by episodes of active disease interrupted by latency periods. There are three characteristic
Full Blown Cardiovascular Syphilis with Aneurysm of the Innominate Artery
The American Journal of Cardiology, 2009
The investigators report the case of a 44-year-old man who presented acutely and was found to have saccular aneurysm of the innominate artery, narrowed or totally occluded aortic arch arteries, and marked thickening of the thoracic aorta except for the wall behind the sinuses of Valsalva. The abdominal aorta was entirely normal. Results of the serologic test for syphilis were strongly positive. Because cardiovascular syphilis appears to be a disease that affects the vasa vasora and because these channels are limited to the thoracic aorta, the abdominal aorta is uninvolved, as demonstrated so nicely in the patient described in this case report. Because most patients with cardiovascular syphilis are much older than the patient described, it is unusual to see a perfectly normal abdominal aorta, as in the present patient. In conclusion, syphilis producing aneurysm of the innominate artery is unusual but is always associated with syphilitic involvement of the thoracic aorta.
Trancranial Doppler Monitoring of Response to Therapy for Meningovascular Syphilis
Journal of Neuroimaging, 2003
Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.
The Journal of Infectious Diseases, 2004
Objective. To define clinical and laboratory features that identify patients with neurosyphilis. Methods. Subjects () with syphilis but no previous neurosyphilis who met 1993 Centers for Disease n p 326 Control and Prevention criteria for lumbar puncture underwent standardized history, neurological examination, venipuncture, and lumbar puncture. Neurosyphilis was defined as a cerebrospinal fluid (CSF) white blood cell count 120 cells/mL or reactive CSF Venereal Disease Research Laboratory (VDRL) test result. Results. Sixty-five subjects (20.1%) had neurosyphilis. Early syphilis increased the odds of neurosyphilis in univariate but not multivariate analyses. In multivariate analyses, serum rapid plasma reagin (RPR) titer у1:32 increased the odds of neurosyphilis 10.85-fold in human immunodeficiency virus (HIV)-uninfected subjects and 5.98-fold in HIV-infected subjects. A peripheral blood CD4 + T cell count р350 cells/mL conferred 3.10-fold increased odds of neurosyphilis in HIV-infected subjects. Similar results were obtained when neurosyphilis was more stringently defined as a reactive CSF VDRL test result. Conclusion. Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system (CNS) early during the course of infection and may elicit meningeal inflammation. The results of studies from the early 1900s [1-5] showed that up to 70% of patients with earlystage syphilis had cerebrospinal fluid (CSF) abnormal
Journal of case reports, 2019
Background: Syphilis is an infectious disease caused by Treponema pallidum with multiple organ involvement in which the central nervous system (CNS) is also affected. Neurosyphilis should be considered in the differential diagnosis of many CNS infections due to its numerous various clinical manifestations. Hemiparesia and complex partial seizures are rare presentations of syphilis. Case Report: A 56 year old male patient was admitted to the emergency department due to fever, syncope and vomiting. His general condition was poor, he was somnolent and partially cooperative, and was disoriented in person and place. MRI resembled HSV encephalitis, mesial temporal syndromes; and increased mononuclear cells in cerebrospinal fluid (CSF) was suggestive for HSV encephalitis. However, CSF and blood tests supported the diagnosis of neurosyphilis. Conclusion: Neurosyphilis should not be overlooked at differential diagnosis in patients presenting with clinical and radiological findings suggestive of herpes encephalitis.
Trends about Cerebral Syphilis in a 31 Young Patient: A Case Study with Cerebral Perfusion (Spect)
Journal of Critical Care & Emergency Medicine
The cerebral syphilis (CS) became occasional because the detection and to the treatment of the disease in its initial phase. It not disappeared and still present in our days. It is priority to consider the solicitude of syphilis serological reactions in diverse manifestations. Now the use of a Gama Camera to obtain images with Nuclear Medicine probes begin a new era in diagnoses about this disease. With a data bank of images obtained in patients committed with this ill it is be possible to reach a good diagnostic and a good following of the patients. In this work we present a clinical case of a patient 31 years old that have cerebral syphilis showing alterations in brain nuclear medicine images that were useful to make a diagnostic of the disease. The images were obtained with a two-head Gama Camera used with the HMPAO binding with 20mCi of Technetium-99m by endogenous injection, they were made tomographic and tridimensional images. It was seen a significant area with hypo perfusion...
Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings
American journal …, 1995
To evaluate and describe the neuroimaging findings of patients with neurosyphilis. METHODS: The neuroimaging studies of 35 patients with documented neurosyphilis were reviewed. Diagnosis was established in 34 patients with cerebrospinal fluid for a Venereal Disease Research Laboratory test, complemented by autopsy in 1 and brain biopsy in 1. All patients had reactive fluorescent treponemal antibody tests with absorption in their sera. Imaging studies included plain and contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, MR angiography, and conventional angiography. Imaging findings were also correlated with the relevant pathologic findings at autopsy in three additional patients with neurosyphilis who did not have brain imaging studies. RESULTS: Of the 35 patients with imaging studies, 32 tested human immunodeficiency virus (HIV)-seropositive, and 3 were HIV-seronegative. Eleven (31%) of 35 patients had normal radiographic findings. Cerebral infarctions were seen in 8 (23%) of 35 patients, and nonspecific white matter lesions in 7 (20%) of 35. Cerebral gummas and extraaxial enhancement indicating meningitis were noted in 2 (6%) of 35 patients, respectively. Arteritis was demonstrated in 2 (50%) of 4 patients who underwent either MR angiography or conventional angiography. The 3 subjects who had autopsy but not imaging studies were found to have manifestations of meningovascular syphilis, including syphilitic leptomeningitis and an obliterative endarteritis. CONCLUSION: We conclude that findings of vascular occlusive disease manifested as infarction or arteritis, enhancing cortical lesions with or without adjacent meningeal enhancement, focal or diffuse extraaxial enhancement, and white matter disease, although nonspecific, in the proper clinical setting should prompt appropriate testing for neurosyphilis, a treatable disease, in patients with and without HIV infection.
Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2018
Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of...