A Stroke in the Young with Surprising Recovery

Abstract

Introduction The differential diagnosis of stroke in a comparatively young adult should always include cardiovascular aetiologies as well as central nervous system infection. Case Presentation A 56-year-old man, with no significant medical history, presented with headache, nausea and vomiting, and right hemiparesis. Routine stroke investigation was initiated, while CNS infection was also sought. Diagnoses of HIV infection, neurosyphilis, HCV and HBV were established. Targeted therapy resulted in prompt clinical improvement. Conclusion This case highlights the importance of considering CNS infection as a cause of neurological deficits in parallel with other investigations in cases of stroke in a comparatively young adult. LEARNING POINTS The differential diagnosis should be wide for all patients presenting with stroke. Neurosyphilis should be included in the differential diagnosis of stroke in the young and middle-aged. Newly diagnosed HIV patients should be screened for other, sexually transmitted coinfection.

Neurosyphilis Presenting as the Lateral Medullary Syndrome

“…Other recent case reports of strokes secondary to neurosyphilis reported these patients were HIV-infected. [13][14][15][16] This case report demonstrated the clinical heterogeneity of neurosyphilis and the importance of extending stroke workup in patients with ischemic stroke who lack common stroke risk factors, especially in HIV-infected patients. Clinicians should be familiar with the clinical presentation of posterior circulation strokes.…”

Problems of Stroke Differential Diagnosis in a Young Patient

“…Кроме того, в последние годы в России на фоне снижения общей заболеваемости сифилисом отмечается увеличение количества скрытых форм данного заболевания, что привело к нарастанию числа случаев нейросифилиса [4]. Однако в доступной научной литературе имеются лишь единичные наблюдения, посвящённые дифференциальной диагностике ишемического инсульта и инфекционных поражений ЦНС, обусловленных вирусом иммунодефицита человека в сочетании с бледной трепонемой [5,6].…”