Prevalence of positive syphilis serology and meningovascular neurosyphilis in patients admitted with stroke and TIA from a culturally diverse population (2005–09)

Abstract

The study aims were to determine the prevalence of positive syphilis serology and meningovascular neurosyphilis (NS) in patients admitted with transient ischaemic attack (TIA) and stroke to a tertiary hospital serving a culturally diverse community. A retrospective cohort analysis was conducted using routinely collected administrative data and medical records to identify patients admitted with TIA, stroke and other conditions, with positive syphilis serology, between 2005 and 2009. Direct medical record review confirmed diagnoses of meningovascular NS. Syphilis serology was requested in 27% (893/3270) of all patients with TIA and stroke (2005-09) of whom 4% (38/893) were positive. Thirty-seven patients with positive serology had clinical characteristics consistent with meningovascular NS. Their mean age was 72±13 years; 65% were male and 68% had a recorded place of birth in South-East Asia or the Pacific Islands. One of 12 patients with suspected meningovascular NS with cerebrospinal fluid (CSF) analysis had a positive CSF Venereal Disease Research Laboratory (VDRL) test. Three patients (8%) met diagnostic criteria for "definite or probable" meningovascular NS. All three patients with a "definite or probable" meningovascular NS and 15 (44%) of the remainder who had positive serology without confirmation of NS were treated with intravenous or intramuscular penicillin. Lumbar puncture (LP) and penicillin were underutilised in patients with TIA and stroke with positive serology. In conclusion, syphilis testing should be considered part of the diagnostic work-up of TIA and stroke, particularly in ethnically diverse populations. In patients with TIA and stroke with positive syphilis serology, it would seem appropriate to further pursue diagnosis and treatment and in patients unable to undergo LP, empiric treatment for NS should be considered.

Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania

“…Syphilis and especially meningovascular neurosyphilis is a well-recognized cause of stroke in young patients. 21 Our results should be interpreted with caution, because no additional diagnostic tests for (neuro)syphilis were performed, including nontreponemal tests or cerebrospinal fluid examination. Still, our data suggest that syphilis testing should be considered part of the work-up of stroke in SSA.…”

Meningovascular syphilis causing recurrent stroke and diagnostic difficulties: a scourge from the past

“…Around a quarter of patients with MVS have prodromal symptoms, likely due to concomitant meningitis—intermittent headaches, vertigo, insomnia or behavioural changes 5 8 11. These may occur for days,11 weeks or even months prior to the ischaemic event 5. The presentation of the ischaemic event itself depends on the vascular territory involved—most commonly the MCA 4 5 11.…”

“…Thus, the most likely manifestations include contralateral hemiplegia, hemianaesthesia, homonymous hemianopia and aphasia 8. Less common locations for the arteritides are the basilar8 or anterior spinal arteries 11…”

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

“…11 Furthermore, false positives can occur with bloodcontaminated CSF. 15 Australia is currently experiencing two distinct syphilis epidemics, among urban men who have sex with men and in heterosexual Aboriginal people in regional and remote areas, predominantly across the Top End. When serological tests are negative, a presumptive diagnosis of neurosyphilis can be made on the basis on an elevated CSF protein or monocytic pleocytosis.…”

“…14 A retrospective Australian study found that syphilis serology was requested in only 27% of patients presenting with stroke, of which 4% were positive. 15 Australia is currently experiencing two distinct syphilis epidemics, among urban men who have sex with men and in heterosexual Aboriginal people in regional and remote areas, predominantly across the Top End. 16 Given the ongoing prevalence of syphilis, and its treatable nature, neurosyphilis needs to be recognised as a rare but important cause of stroke.…”