Isolated middle cerebral artery stenosis caused by syphilitic vasculitis

Abstract

Background. Syphilitic vasculitis (SV) is rare and difficult to be diagnosed. High-resolution vessel wall magnetic resonance imaging (HR-VWI) might be valuable in the diagnosis by differentiating SV from other vessel wall pathologies. Methods. We report a rare case with severe isolated middle cerebral artery (MCA) stenosis and cerebral infarction, which was evaluated by serial HR-VWI. Results. A 46-year-old woman presented with an acute infarct in the left basal ganglia and severe isolated stenosis in left middle cerebral artery (MCA). Cerebrospinal fluid (CSF) analysis was performed and the findings were consistent with neurosyphilis diagnosis. The MCA stenosis was also suspected to be the result of SV. HR-VWI revealed the evidence of concentric thickening and circular uniform enhancement of the arterial wall. After two cycles of antisyphilis treatment, subsequent HR-VWI showed that the MCA stenosis was reduced significantly except slight enhancement of the arterial wall, which confirmed that the SV caused the isolated MCA stenosis. Conclusions. HR-VWI could be an important diagnostic tool for isolated middle cerebral artery stenosis caused by SV, which could serve as a biomarker for assessing the response to anti-syphilis treatment in the future.

Cerebral infarction as initial manifestation of meningovascular neurosyphilis in an immunocompetent patient – A case report with long term follow‐up

“…Such treatment resulted in an almost complete regression of stenoses that involved major intracranial arteries on a late follow‐up MRA done months after antimicrobial treatment. This is also in a line with previously described results, confirming the treatment effectiveness which could be used as a non‐invasive biomarker of treatment response 13 . Furthermore, in our patient corticosteroids were not applied, although some authors recommend them for meningovascular neurosyphilis treatment 13,14 .…”

“…This is also in a line with previously described results, confirming the treatment effectiveness which could be used as a non‐invasive biomarker of treatment response 13 . Furthermore, in our patient corticosteroids were not applied, although some authors recommend them for meningovascular neurosyphilis treatment 13,14 . According to the treatment of our patient whom corticosteroids were not given, an antimicrobial treatment given only might guarantee a favorable therapeutic effect.…”

“…13 Furthermore, in our patient corticosteroids were not applied, although some authors recommend them for meningovascular neurosyphilis treatment. 13,14 According to the treatment of our patient whom corticosteroids were not given, an antimicrobial treatment given only might guarantee a favorable therapeutic effect.…”