Angiographic findings in a young man with recurrent stroke and positive fluorescent treponemal antibody (FTA).

Abstract

SUMMARY A young man with a history of two strokes was found to have serologic evidence of a prior syphilitic infection, abnormal spinal fluid, and angiographic evidence of diffuse intracranial and extracra nial angiopathy which we believe was due to tertiary syphilis, although his use of oral amphetamines cannot be ruled out as a contributing factor. This is the first reported case in which angiography has demonstrated both intracranial and extracranial disease arterial disease due to neurosyphilis. Since syphilis can produce diffuse cerebral arterial changes, this diagnosis should be considered in young patients with stroke even when non-treponemal serologic tests are negative.

Clinical and imaging findings in patients with neurosyphilis: a study of a cohort and review of the literature

“…These may result from insult to perforating arteries by endarteritis, causing cortical and subcortical infarcts, leptomeningeal enhancement, meningitis, and arteritis . Neurosyphilis resulting in cerebral infarctions was found to be common in our study, as in previous research …”

“…7,13 Neurosyphilis resulting in cerebral infarctions was found to be common in our study, as in previous research. 7,11,14 The presentation of neurosyphilis has changed over the last 40 years. 15 Patients now tend to present atypically with seizures, ophthalmic symptoms such as poor vision, stroke, confusion, or personality changes.…”

Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature

“…In the literature, we found one report of a patient with recurrent ischemic strokes and serologic evidence of a previously treated syphilis infection (positive fluorescent treponemal antibody with negative VDRL on both peripheral blood and cerebrospinal fluid), in whom an angiography demonstrated both intracranial and extracranial arterial diseases due to neurosyphilis. 10 In another case, a fatal vertebrobasilar occlusion occurred in a patient with laboratory findings of a prior spirochetal infection and evidence, at autopsy, of anatomopathological elements suggestive for meningovascular syphilis. 11 …”

The Great Masquerader: Recurrent Ischemic Strokes Secondary to Meningovascular Syphilis in a Man With Cardiovascular Stroke Risk Factors

“…Syphilis does not necessarily need to progress to the final stages of the disease to affect the nervous system. Thus, patients with a history of other STDs, HIV, and recurrent strokes, particularly in young patients, might benefit from routine screening with non-treponemal antibodies [ 10 ].…”