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[Bilateral internal carotid artery stenoses in a patient with meningovascular neurosyphilis]
Y Ohya1, T Matsumura, S Kojima
1Department of Neurology, Toranmon Hospital.
Abstract:
We report a 37-year-old man with cerebral infarction due to meningovascular neurosyphilis. He developed right hemiplegia and motor aphasia preceded by left retroorbital pain lasting a month. Bilateral tonic pupils were also observed. Magnetic resonance imaging (MRI) disclosed cerebral infarction in the distribution of perforating branches of the left middle cerebral artery. Abnormal enhancement was absent in the meninges on T1-weighted MRI examination. SPECT study with I-123 iodoamphetamine showed decreased perfusion in the area of the left middle cerebral artery on early phase. A delayed SPECT 4 hour later demonstrated redistribution of the cerebral blood flow in the area of its cortical branches. On cerebral angiograms, marked stenoses were disclosed at the supraclinoid segments of the bilateral internal carotid arteries as well as the M1 segment of the left middle cerebral artery. These stenoses were associated with increased collateral circulations on the left side. Atherosclerosis was not apparent, on angiography. The cerebrospinal fluid (CSF) showed pleocytosis and positive TPHA. The CSF/serum ratio of TPHA was 1/16. Oligoclonal IgG band was present in the CSF. CSF IgG index was elevated. These findings were consistent with meningovascular neurosyphilis. Causes of angiitis other than syphilis were excluded. A test for antibodies against human immunodeficiency virus was negative. The clinical course of his recovery was similar to that in patients with atherosclerotic thrombosis. The stenosis of the right internal carotid artery demonstrated by angiography could not be expected from the clinical manifestations and SPECT study.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Meningovascular neurosyphilis caused cerebral infarction in a 37-year-old man, presenting with hemiplegia and aphasia. Diagnosis involved MRI, SPECT, angiography, and cerebrospinal fluid analysis confirming neurosyphilis.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Neurology
Background:
- Meningovascular neurosyphilis is a rare cause of stroke.
- Cerebral infarction can manifest with focal neurological deficits.
Observation:
- A 37-year-old man presented with right hemiplegia, motor aphasia, and retroorbital pain.
- Neurological examination revealed bilateral tonic pupils.
- Neuroimaging showed cerebral infarction, arterial stenoses, and decreased cerebral blood flow.
Findings:
- Cerebrospinal fluid analysis revealed pleocytosis, positive TPHA, oligoclonal IgG bands, and elevated IgG index, consistent with neurosyphilis.
- Cerebral angiography demonstrated stenoses in the internal carotid and middle cerebral arteries without signs of atherosclerosis.
- SPECT imaging indicated reduced perfusion and subsequent redistribution of cerebral blood flow.
Implications:
- This case highlights meningovascular neurosyphilis as a treatable cause of cerebral infarction and arterial stenosis.
- Early diagnosis and treatment are crucial for favorable outcomes in neurosyphilis-related stroke.
- The findings emphasize the importance of considering infectious etiologies in young stroke patients with arterial abnormalities.