A Fatal Fall Associated With Undiagnosed Parenchymatous Neurosyphilis

Abstract

A fall from a great height is often associated with altered mental status. Aside from the usual contributing factors, for example, alcohol consumption or mental illness, natural disease leading to a fatal fall is seldom identified by autopsy. The case described in this report is that of a 57-year-old man who had been clinically diagnosed with presenile Alzheimer disease and fell head first into a river from the bridge. These events were captured by a surveillance camera on the bridge; an acquaintance reported that he had previous suicidal ideation. At autopsy, the cervical spinal cord was determined to have been severely injured, and the sixth cervical vertebra was observed to have been fractured. Histological examination showed chronic meningoencephalitis including neuronal loss, perivascular cuffing, and the proliferation of microglia and astrocytes in the cerebral cortex. Serologic evaluation consisting of the nontreponemal antigen test (rapid plasma reagin [RPR]) and treponemal antibody test (Treponema pallidum latex agglutination) was positive in both cases (RPR: 18.2 RPR units, T. pallidum latex agglutination: 7718 U/mL). These findings suggested that the patient had been affected by a syphilis infection and that his suicidal behavior was associated with parenchymatous neurosyphilis.

Autopsy case of acute pulmonary thromboembolism with neurosyphilis

“…Histologically, the inflammation is mononuclear, specifically lymphoplasmacytic, as in the present case (Feng et al 2009). Neurosyphilis also causes Heubner arteritis, which is characterized by thickening and lymphocytic infiltration of the intima, which can induce a stroke syndrome (Brown and Gray 2008;Sakai et al 2014). However, there was no evidence of Heubner arteritis in the present case.…”

“…We examined the case focusing on signs of late-stage syphilis. One forensic case of suicide associated with neurosyphilis has been reported (Sakai et al 2014). The present case highlights the importance of collecting antemortem clinical data for successful autopsy diagnosis and documentation.…”

“…The present case highlights the importance of collecting antemortem clinical data for successful autopsy diagnosis and documentation. Further, the likelihood of encountering undiagnosed neurosyphilis should be considered in the future (Sakai et al 2014).…”

Increased CSF Soluble TREM2 Concentration in Patients With Neurosyphilis

“…NS is a chronic infectious disease caused by Treponema pallidum invading the central nervous system (CNS), which mainly damages the meninges, blood vessels, and brain, and spinal cord parenchyma (1,2). A large number of activated microglia were found in the brain autopsies of NS, demonstrating that the microglial activation was an important pathological feature of NS (3,4), which was rarely studied in CSF samples of patients with NS.…”

“…Increased soluble TREM2 (sTREM2) levels in CSF have been found in HIV infection (8), multiple sclerosis (MS) (9,10), and Alzheimer's disease (AD) (11,12). However, over activation of microglia may result in neuronal loss and neuropil damage (3,4). Neurofilament light proteins (NFL) are the most widely distributed and important component of neurofilament proteins (NFs) (13).…”