Medial medullary stroke due to neurosyphilis in a newly diagnosed HIV‐positive man

Katelaris, Annette; Janson, Sonja; Ramachandran, Prashanth; Spencer, Emma

doi:10.1111/imj.13974

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Meningovascular disease, through the mechanism of small, medium and large vessel arteritis, can manifest as an infarct indistinguishable from cerebrovascular stroke [4] . The diagnosis of neurosyphilis in HIV patients can be difficult for several reasons: (a) CSF serology for VDRL may only be positive in approximately one third of cases; (b) HIV infection itself can cause CSF pleocytosis and an increased protein level; and (c) HIV-associated vasculopathy can contribute to inflammation of the cerebral blood vessels through different mechanisms such as vasculitis, accelerated atherosclerosis and aneurysm formation [5, 6] . Brain MRI findings may demonstrate characteristic but non-specific findings of neurosyphilis, including general atrophy and mesial temporal atrophy [7] , as well as infarct in the midline medulla and left pyramid (as described in our patient).…”

Section: Discussionmentioning

confidence: 99%

A Stroke in the Young with Surprising Recovery

Cohen

Shpitalni

Lifshitz

et al. 2019

European Journal of Case Reports in Internal Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

A Stroke in the Young with Surprising Recovery

Cohen

Shpitalni

Lifshitz

et al. 2019

European Journal of Case Reports in Internal Medicine

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“…Insidensen av syfilis er imidlertid økende (17), og det er påvist at bakenforliggende syfilis ofte oversees hos hjerneinfarktpasienter (11). Det er derfor foreslått at det bør utføres screening for syfilis hos disse pasientene (7,11,12,19,20). Screeningtest gjøres i dag relativt enkelt og rimelig med helautomatisert undersøkelse av T. palliumtotalantistoff i serum (2).…”

Section: Diskusjonunclassified

En mann i 40-årene med akutt innsettende talevansker og ensidig lammelse

Jahr¹,

Myro²,

Vegge³

et al. 2019

Tidsskriftet

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Nevroklinikken Akershus universitetssykehus Silje Holt Jahr er lege i spesialisering. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. AIJA ZULERON MYRO Nevroklinikken Akershus universitetssykehus Aija Zuleron Myro er overlege i nevrologi. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KJETIL VEGGE Bildediagnostisk avdeling Akershus universitetssykehus Kjetil Vegge er overlege i radiologi. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. PATRICIA CAMPBELL Mikrobiologi og smittevern Akershus universitetssykehus og Nasjonal kompetansetjeneste for seksuelt overførbare infeksjoner Oslo universitetssykehus Patricia Campbell er overlege i mikrobiologi. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. En mann i slutten av 40-årene ble innlagt med akutt innsettende slagsymptomer. Utredningen avslørte en sykdom som ofte glemmes, men som forekommer i økende grad og er behandlingstrengende.

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Neurosyphilis in the Northern Territory of Australia: a clinical guideline

Birrell

Lowe

Gunathilake

et al. 2022

Internal Medicine Journal

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Background The Northern Territory (NT) of Australia is currently experiencing a syphilis epidemic. Neurosyphilis is commonly considered in the differential diagnosis for patients presenting with neurologic conditions such as dementia and stroke in the NT. Aims To explore the local epidemiologic, diagnostic and treatment complexities of neurosyphilis in the NT and produce a guideline for clinical practice. Methods A database search was undertaken and local and global neurosyphilis guidelines were analysed. A guideline was created based on findings of the critical review and consultation with local multidisciplinary experts. Results Neurosyphilis is frequently encountered in the NT but studies suggest it is often undertreated. Dementia is the most common clinical presentation locally. Establishing a diagnosis of neurosyphilis is complex and requires stepwise evaluation of clinical, laboratory and radiological findings. Conclusions A clinical guideline and algorithm have been developed for the diagnosis and management of patients with neurosyphilis.

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Medial medullary stroke due to neurosyphilis in a newly diagnosed HIV‐positive man

Cited by 3 publications

References 15 publications

A Stroke in the Young with Surprising Recovery

A Stroke in the Young with Surprising Recovery

En mann i 40-årene med akutt innsettende talevansker og ensidig lammelse

Neurosyphilis in the Northern Territory of Australia: a clinical guideline

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