Neurosyphilis presenting with focal middle cerebral artery stenosis and acute ischemic stroke: A case report

Radiology Case Reports

article

Lauryn Currens¹  Shravan Sivakumar¹  Adalia H. Jun-O'Connell¹  Carolina Ionete¹  Mehdi Ghasemi¹ 

[1] Department of Neurology, University of Massachusetts Chan Medical School

关键词: Neurosyphilis;    Stroke;    Ischemic stroke;    Acute cerebrovascular event;    Middle cerebral artery stenosis;    Magnetic resonance imaging (MRI);   

DOI  :  10.1016/j.radcr.2022.02.044

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

Despite widespread screening and active management of syphilis infection, the rate of secondary and tertiary syphilis has increased over the past decade in the United States, especially with human immunodeficiency virus co-infection. We report a case of ischemic strokes in the middle cerebral artery (MCA) territory with focal stenosis of the left M1 segment of the MCA resulting from neurosyphilis with manifestation of subacute intermittent right-sided hemi-body numbness and transient word finding difficulties in a young adult with no prior known history of syphilis or significant cerebrovascular risk factors. A diagnostic cerebral angiogram was done which was initially concerning for possibility of reversible cerebral vasoconstriction syndrome (RCVS). The serum Treponema pallidum RPR testing resulted positive (1:32 titer) as well as subsequent reactive cerebrospinal fluid (CSF) VDRL test (ratio, 1:8). The patient was treated with intravenous ceftriaxone as well as verapamil and recovered without any residual deficits. To the best of our knowledge, this is the first reported evidence of possible RCVS in a case of neurosyphilis and related ischemic stroke. This case underscores the importance of evaluation for syphilis in young patients with fewer known vascular risk factors, who present with an ischemic stroke. Given the higher rates of stroke recurrence in neurosyphilis relative to few other stroke risk factors, early diagnosis, and treatment is furthermore essential to prevent disease progression.

【 授权许可】

CC BY|CC BY-NC-ND