Dados do Trabalho

Título

Meningovascular syphilis presenting with acute ischemic stroke due to intracranial arteries stenosis: case report

Descrição do caso

Introduction: Meningovascular syphilis is a recognized cause of stroke, but its diagnosis is challenging due to atypical presentations. Adequate diagnosis is essential for improving patient outcomes.
Case report: A 39-year-old HIV-positive male (CD4 count: 201; viral load: 81 copies), presented with a sudden transient left hemiparesis and dysarthria that lasted two minutes. A head computed tomography (CT) angiography revealed diffuse intracranial vascular narrowing and inflammation in the cerebrospinal fluid (CSF) with a positive VDRL test (1:8). He was treated for meningovascular syphilis, with clinical improvement and discharge. One month later, he was readmitted with respiratory failure due to bacterial pneumonia and tuberculosis, requiring orotracheal intubation. After awakening, left hemiparesis, hemineglect, and severe dysarthria were noted. Neuroimaging revealed right frontoparietal ischemia and worsening stenosis of the right middle cerebral artery (MCA). CSF analysis showed pleocytosis, and VDRL test was positive (1:8). Additional treatment for neurosyphilis was initiated with crystalline penicillin for 14 days, with clinical improvement and discharge. Follow-up CSF VDRL titer reduced to 1:4.
Comments: Meningovascular syphilis is an important cause of intracranial stenosis in younger stroke patients. While focal of the MCA stenosis is common, diffuse intracranial vessel stenosis due to neurosyphilis is rare. The patient's concurrent pulmonary tuberculosis and the recent neurosyphilis treatment added complexity to the diagnosis. Recent evidence indicates high recurrent ischemic stroke rates in neurosyphilis compared to other causes. Neurosyphilis should be considered in young adults, particularly those with HIV, and prompt comprehensive treatment is essential to reduce recurrent stroke rates.