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| LETTER TO EDITOR |
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| Year : 2014 | Volume
: 62
| Issue : 2 | Page : 213-214 |
Meningovascular syphilis with basilar artery occlusion: Case report and literature review
Yao Yin-Dan, Hong Wen-Ke, Guan Li-Feng
Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| Date of Submission | 17-Jan-2014 |
| Date of Decision | 17-Jan-2014 |
| Date of Acceptance | 08-Apr-2014 |
| Date of Web Publication | 14-May-2014 |
Correspondence Address:
Yao Yin-Dan
Department of Neurology, Ningbo No. 2 Hospital, Ningbo
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.132427
How to cite this article:
Yin-Dan Y, Wen-Ke H, Li-Feng G. Meningovascular syphilis with basilar artery occlusion: Case report and literature review. Neurol India 2014;62:213-4 |
Sir,
A 45-year-old man known case of diabetes was admitted for new-onset occipital headache, right-sided weakness, dysarthria, and right facial droop. Examination revealed dysarthria, right upper motor neuron facial palsy, and right hemiparesis (upper limb 2/5 and lower limb 4/5). Noncontrast computed tomographic bran scan was normal. Blood biochemistry and complete blood picture laboratory were normal. The tolulized red unheated serum test (TRUST) (1:16) and Treponema pallidum  magglutination assay (TPHA) test were positive. Human immunodeficiency virus serology was negative. On the 4 th day of admission, his neurologic signs worsened and progressed to quadriplegia. Neurologic examination revealed severe dysarthria, dysphagia, and quadriplegia (left upper limb 4/5, left lower limb 3/5, right upper limb 2/5 and right lower limb 2/5). Magnetic resonance imaging demonstrated multiple acute infarcts involving scattered regions of the left cerebellar hemisphere and both side of the pons [Figure 1]a and b. Magnetic resonance-angiography revealed the absence of flow signal within the distal basilar artery, indicating an acute occlusion and a large saccular aneurysm in the middle artery was found [Figure 1]c. On day-5 cerebrospinal fluid (CSF) revealed 280 white blood cells/ul (26% lymphocytes), glucose 3.19 mmol/L, and protein 0.96 g/L. The CSF TRUST was positive (1:4). A diagnosis of meningovascular syphilis was made and was treated with intravenous penicillin G (4 million units every 4 h) for 2 weeks. Neurologic signs fluctuated in severity for the next 10 days after therapy was initiated, but later improved steadily. On day-20, follow-up computed tomographic-angiography revealed basilar artery occlusion with improved distal flow [Figure 1]d. The patient was discharged on day-21 and instructed to follow-up with primary physician in his local hospital. | Figure 1: (a) Diffusion-weighted and (b) T2-weighted magnetic resonance images show multiple acute infarcts involving scattered regions of the left cerebellar hemisphere and both side of the pons. (c) Magnetic resonance-angiography shows absence of flow signal within the distal basilar artery (arrow) and a large saccular aneurysm (arrowhead) in the middle cerebral artery. (d) Follow-up computed tomographic angiography shows basilar artery occlusion with improved distal flow (arrow)
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Neurosyphilis is known as "the great impostor" because of its wide range of clinical symptoms. Once a common disease, meningovascular syphilis has become rare since the advent of antibiotics. However, with the rise in the incidence of primary and secondary syphilis, [1] meningovascular syphilis may become a more common cause for stroke. In clinical practice, neurosyphilis as the cause of ischemic stroke is often not suspected. Diagnosis of neurosyphilis has therapeutic implication and non-or delayed institution of early appropriate treatment would result in more morbidity. [2] Most frequent clinical presentation of meningovascular syphilis is stroke presentation in the middle cerebral artery territory and vertebrobasilar artery and its branches are the second most commonly involved vessels. [3],[4] Syphilis can cause the cause of aortic aneurysm, however cerebral aneurysm secondary to syphilitic vasculopathy has been reported rarely. [5] Clinical suspicion and early diagnosis and early institution appropriate treatment is important to reduce the morbidity associated with the disease.
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| 1. | Chen XS, Yin YP, Wang QQ, Wang BX. Historical perspective of syphilis in the past 60 years in China: Eliminated, forgotten, on the return. Chin Med J (Engl) 2013;126:2774-9. 
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| 2. | Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG, et al. Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. J Neurol Sci 2012;317:35-9.
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| 3. | Flint AC, Liberato BB, Anziska Y, Schantz-Dunn J, Wright CB. Meningovascular syphilis as a cause of basilar artery stenosis. Neurology 2005;64:391-2.
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| 4. | Feng W, Caplan M, Matheus MG, Papamitsakis NI. Meningovascular syphilis with fatal vertebrobasilar occlusion. Am J Med Sci 2009;338:169-71.
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| 5. | Asdaghi N, Muayqil T, Scozzafava J, Jassal R, Saqqur M, Jeerakathil TJ. The re-emergence in Canada of meningovascular syphilis: 2 patients with headache and stroke. CMAJ 2007;176:1699-700.
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