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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 2  |  Page : 213-214

Meningovascular syphilis with basilar artery occlusion: Case report and literature review


Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China

Date of Submission17-Jan-2014
Date of Decision17-Jan-2014
Date of Acceptance08-Apr-2014
Date of Web Publication14-May-2014

Correspondence Address:
Yao Yin-Dan
Department of Neurology, Ningbo No. 2 Hospital, Ningbo
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.132427

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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

How to cite this URL:
Yin-Dan Y, Wen-Ke H, Li-Feng G. Meningovascular syphilis with basilar artery occlusion: Case report and literature review. Neurol India [serial online] 2014 [cited 2021 May 15];62:213-4. Available from: https://www.neurologyindia.com/text.asp?2014/62/2/213/132427


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 Scientific Name Search 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.

 
  References Top

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.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
4.Feng W, Caplan M, Matheus MG, Papamitsakis NI. Meningovascular syphilis with fatal vertebrobasilar occlusion. Am J Med Sci 2009;338:169-71.  Back to cited text no. 4
    
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.  Back to cited text no. 5
    


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