Neurosyphilis presenting with a stroke-like syndrome

Abstract

SUMMARYNeurosyphilis results from infection of the central nervous system (CNS) by Treponema pallidum. Neurosyphilis can occur at any time after initial infection, particularly in immunocompromised patients. We describe a case of a 47-year-old man who presented with mixed dysphasia, right upper motor neuron facial palsy and right hemiparesis. Collateral history from the family revealed slowly progressive cognitive impairment and behavioural changes. Neuroimaging was unremarkable, suggesting a non-vascular aetiology. As there was no clear cause for the presentation, a lumbar puncture was performed and serum samples were sent for syphilis serology. The diagnosis of neurosyphilis was made on the basis of a positive RPR test in cerebrospinal fluid. The patient was treated with benzylpenicillin and made a full recovery, with restoration of cognitive function to baseline. BACKGROUND

Neurosyphilis presenting as acute ischemic stroke

“…8 There is also a possibility of false positive results if the CSF sample is contaminated with a substantial amount of blood, especially if the serum VDRL titres are low. 9,10 Classically, CSF pleocytosis and elevated protein are expected in neurosyphilis; however, normal findings have been reported as well. 11 Our patient displayed an acute ischaemic stroke involving the left MCA territory, with mild prodromal symptoms of headache.…”

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

“…I tillegg forekommer en symptomfri periode med latent syfilis forut for det tertiaere stadiet (6). Diagnostisering av syfilis er utfordrende på grunn av sykdommens atypiske presentasjonsformer og dens likhet med andre sykdommer (7). Syfilis kalles derfor ofte den store imitator (4,8).…”

“…5 % av ikke-behandlede syfilispasienter med invasjon av sentralnervesystemet utvikler symptomatisk nevrosyfilis, vanligvis innen de første måneder eller år etter smitte, men pasienten kan vaere asymptomatisk i årevis (10). Syfilis kan affisere nervesystemet på mange måter, og dette kan resultere i fokale nevrologiske utfall eller global dysfunksjon i sentralnervesystemet (7). Nevrosyfilis inndeles derfor i fem ofte overlappende kategorier: Asymptomatisk, meningeal, meningovaskulaer, parenkymatøs og gummatøs (11).…”

“…Dette kan medføre fokale nevrologiske utfall samt fokale eller generaliserte anfall (8). Rundt 10 % av pasientene med nevrosyfilis presenterer seg med hjerneinfarkt (7). Hjerneinfarkt forårsaket av nevrosyfilis kan ha prodromer i månedsvis i form av for eksempel hodepine, vertigo, insomni, emosjonell labilitet og personlighetsforandringer (9).…”

Mona Lisa Decrypted: Another Premise

“…7 Much rarer etiologies are vasculitis, trauma, and infectious processes including neurosyphilis. [7][8][9][10][11][12][13] I also submit that the position of the lesion of the right wrist is more in keeping with a ganglion cyst than a lipoma.…”