Neurosyphilis vasculitis manifesting as ischemic stroke

Abstract

FIGURE 1: Axial DWI and T2-weighted MRI showing left hemipons infarction (arrows, A and B). Three-dimensional timeof-flight magnetic resonance angiography showing significant stenosis of the basilar artery (arrow, C). 2/2 Feitoza LM et al. -Neurosyphilis vasculitis OPEN ACCESS https://creativecommons.org/licenses/by/4.0/

Progressive Stroke Caused by Neurosyphilis With Concentric Enhancement in the Internal Cerebral Artery on High-Resolution Magnetic Resonance Imaging: A Case Report

“…The entire M1 segment of the left MCA and the A1 segment of the left ACA were involved, suggesting a high possibility of arteritis. Previous studies have reported similar concentric enhancement in the BA due to syphilitic arteritis (3,4). Concentric enhancement on HR-MRI may help identify syphilitic arteritis.…”

“…Therefore, the identification of neurosyphilis during the early stages of the disease is essential. Apart from serum or cerebrospinal fluid (CSF) findings of T. pallidum, high-resolution magnetic resonance imaging (HR-MRI) indicating arteritis can help differentiate neurosyphilis from strokes caused by other factors (3,4). Here, we present a unique case of progressive stroke caused by neurosyphilis and radiological characteristics of the intracranial vessel wall imaging.…”

Neurosyphilis Presenting as the Lateral Medullary Syndrome

“…Other recent case reports of strokes secondary to neurosyphilis reported these patients were HIV-infected. [13][14][15][16] This case report demonstrated the clinical heterogeneity of neurosyphilis and the importance of extending stroke workup in patients with ischemic stroke who lack common stroke risk factors, especially in HIV-infected patients. Clinicians should be familiar with the clinical presentation of posterior circulation strokes.…”

High-Resolution Vessel Wall MRI as a Complementary Investigation for CNS Tuberculosis

“…1 HR-VWI complements luminal imaging and can differentiate many potential causes of luminal narrowing. [2][3][4] Vessel wall enhancement usually corresponds to expected patterns of vessel wall inflammation and/or increased vasa vasorum density in distinct vascular pathologies 2 and can also detect cranial nerve enhancement, 4 as illustrated in this report. MRI with HR-VWI is a relevant tool to demonstrate TBM arteritis and can identify vessel wall enhancement without changes in the vessel caliber.…”

“…1 Autoimmune mechanisms have also been suspected in these cases since they can appear even during effective treatment. The recent development of a new magnetic resonance imaging (MRI) sequencethe high-resolution vessel wall imaging (HR-VWI)has allowed submillimeter MRI evaluation of arterial walls [2][3][4] and can contribute to the diagnosis of this disease.…”