Meningovascular neurosyphilis with basilar artery thrombosis, a case report and literature review

Jiménez, Jorge Andrés; Ladino, Lady Diana; Uribe, Carlos Santiago; Guerra, Alejandro; Diego, Juan Albarrán; Hernández, O; Ochoa, Jorge Andrés

doi:10.7705/biomedica.v32i1.586

Cited by 1 publication

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References 21 publications

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“…[46][47][48][49][50][51] Although the distribution of the middle cerebral artery is the territory most commonly affected, there are reports of posterior circulation strokes including basilar and vertebral artery occlusion. 52,53 Bilateral involvement is not uncommon, as would be expected in a CNS vasculitis. Merritt reported on the CSF findings of two patients in the prepenicillin era; one had 80 WBC/mL and the other 700 WBC/ mL, the first patient had a CSF protein level of 120 mg/dL.…”

Section: Clinicalmentioning

confidence: 97%

Neurosyphilis

2019

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Neurosyphilis is caused by the bacterium Treponema pallidum subspecies pallidum (T. pallidum). The organism gains entry into the central nervous system (CNS) early (primary syphilis or chancre phase) in the course of infection. While most patients are able to mount an immune response that effectively clears CNS invasion without long-term complications, a minority go on to develop asymptomatic or symptomatic neurosyphilis. Neurosyphilis has been divided into early and late stages. The early stages include asymptomatic meningitis, symptomatic meningitis, gumma, and meningovascular syphilis, while the late stages include dementia paralytica and tabes dorsalis. Ocular and otologic syphilis can occur at any time but often accompany the acute meningitis of early neurosyphilis. The diagnosis of symptomatic neurosyphilis requires meeting clinical, serologic, and cerebrospinal fluid (CSF) criteria, while the diagnosis of asymptomatic neurosyphilis relies on serologic and CSF criteria alone. In the last several decades, a persistent rise in syphilitic meningitis and other forms of early neurosyphilis have been seen in the human immunodeficiency virus-positive population, principally in men who have sex with men. This article reviews the clinical presentation, diagnosis, and treatment of neurosyphilis, and it addresses the controversy regarding the role of lumbar puncture early in the course of infection.

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