Meninigovascular syphilis presenting as acute ischemic stroke in an HIV + young adult: A case report and a brief literature review

Abstract

Background Meningovascular syphilis, a distinct classification of neurosyphilis, has gained attention for its association with cerebral ischemia, particularly among individuals living with HIV. This unique manifestation of syphilis affects the meningeal and vascular structures of the central nervous system, leading to cerebrovascular complications. Notably, in young patients who present with stroke-like symptoms, especially within the context of HIV infection, should prompt suspicion of meningovascular syphilis Case presentation A right-handed male patient presented with a sudden paresis of the right upper and lower extremities, along with facial deviation to the left and low verbal output, constructing sentences, and conveying thoughts or ideas effectively. Upon admission, the patient's neurological examination revealed a Glasgow Coma score of 10A. He exhibited motor aphasia, right facial paralysis sparing the forehead, and right upper and lower extremity spastic hemiparesis with a strength of 3 out of 5 on the Medical Research Council scale. The Plantar reflex was positive on the affected side. Brain Magnetic resonance imaging revealed left middle cerebral artery infarction (cortical and lenticulostrial territory acute infarction). Conclusion: The authors recommend treating physician to have a high index of suspicion towards meningovascular syphilis as a potential cause of stroke in young individuals. This is crucial, especially when there is also a concurrent HIV infection, as it can significantly affect treatment decisions.