Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series

Borges, Conrado Regis; Almeida, Sérgio Monteiro de; Sue, Karen; Koslyk, Jéssyca Luana Alves; Sato, Mário Teruo; Shiokawa, Naoye; Teive, Hélio Afonso Ghizoni

doi:10.1590/0004-282x20180054

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Syphilis is considered an endemic disease in Latin America, with an estimated prevalence of positive tests of 2.6% in the general population 3,10 . This investigation identified 12% of positive tests in stroke patients, which is close to previous studies, whose values were between 4 and 8.4% 11,12 .…”

Section: Discussionmentioning

confidence: 99%

Small vessel occlusion and syphilis in patients with first-ever ischemic stroke

Ferreira

Scavasine

Breda

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis. Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD). Methods: In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Patients with neurosyphilis were excluded. All patients were classified according to the ASCOD phenotyping as SVD — when SVD was the potential causal mechanism (S1) — or non-SVD — when SVD was uncertain (S2), unlike (S3), or not detected (S0). Results: Syphilis was positive in 32 (12%) patients. When comparing patients with positive and negative serology, the only significant difference was SVD as the causal mechanism (S1) in patients with positive results: 9 (28%) vs. 22 (9%), p<0.01. Conclusion: The current study showed that the frequency of positive syphilis serological test was higher in patients with first-ever ischemic stroke and SVD as the potential causal mechanism. This finding could be related to the endothelial dysfunction occurring in syphilis.

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Section: Discussionmentioning

confidence: 99%

Small vessel occlusion and syphilis in patients with first-ever ischemic stroke

Ferreira

Scavasine

Breda

et al. 2021

Arq. Neuro-Psiquiatr.

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“…Por lo cual no se puede afirmar ni descartar el compromiso encefálico, como es el caso de nuestro paciente. (1,3,9) Esta situación es reportada en la literatura internacional. En la serie de Romero et al (4) en Chile, 4/10 casos de sífilis ocular tenían el análisis citoquímico del LCR normal con VDRL negativo.…”

Section: Discussionunclassified

Sífilis ocular como manifestación de neurolues. A propósito de un caso clínico.

Fagundez

Calistro

Castrillón

et al. 2020

RUMI

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Sífilis ocular como manifestación de neurolues.A propósito de un caso clínico.Ocular syphilis as a manifestation of neurolues. About a clinical case.Sífilis ocular como manifestação de neurolores. Sobre um caso clínico.Resumen: La sífilis ocular es una forma infrecuente de neurosífilis, que se puede presentar en cualquier estadio de la enfermedad. La presentación clínica puede ser heterogénea, siendo la forma más frecuente la uveítis. El diagnóstico se confirma con serología, debiéndose realizar estudio del líquido cefalorraquídeo para descartar compromiso meníngeo. Su detección y tratamiento precoz permiten la prevención de complicaciones neurológicas como la ceguera irreversible. Presentamos el caso clínico de un paciente que se presenta con panuveítis y diagnóstico serológico de sífilis presentando excelente respuesta al tratamiento instaurado.

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“…Only quite a few cases of syphilitic myelitis have been documented in the reported literature. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis in the literature[4,7-21]. We herein report a case of syphilitic myelitis with longitudinally extensive myelopathy presenting with the characteristic of "flip-flop sign" on spinal magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 94%

Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging

Yuan

Wang

2019

WJCC

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BACKGROUND Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported. Only a few cases of syphilitic myelitis have been documented. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis. However, the clinical features of syphilitic myelitis with longitudinally extensive myelopathy have been still not clear. AIM To explore the clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging (MRI). METHODS First, we report a patient who suffered from syphilitic myelitis with symptoms of sensory disturbance, with longitudinally extensive myelopathy with "flip-flop sign" on spinal MRI. Second, we performed a literature search to identify other reports (reviews, case reports, or case series) from January 1987 to December 2018, using the PubMed and Web of Science databases with the terms including "syphilis", "neurosyphilis", "syphilitic myelitis", "meningomyelitis", "central nervous system", and "spine". We also summarized the clinical features of syphilitic myelitis with longitudinally extensive myelopathy. RESULTS A total of 16 articles of 20 cases were identified. Sixteen patients presented with the onset of sensory disturbance (80%), 15 with paraparesis (75%), and 9 with urinary retention (45%). Eleven patients had a high risk behavior (55%). Five patients had concomitant human immunodeficiency virus infection (25%). Serological data showed that 15 patients had positive venereal disease research laboratory test (VDRL)/treponema pallidum particle agglutination (TPHA), and 17 had positive VDRL/TPHA in cerebrospinal fluid (CSF). Seventeen patients were found to have elevated leukocytosis and protein in CSF. On MRI, 16 patients showed abnormal hyperintensities involved the thoracic spine, 6 involved the cervical spine, and 3 involved both the cervical and thoracic spine. There were 3 patients with the "flip-flop sign". All the patients were treated with penicillin, and 15 patients had a good prognosis. CONCLUSION Our case further raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries such as China.

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Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series

Cited by 14 publications

References 19 publications

Small vessel occlusion and syphilis in patients with first-ever ischemic stroke

Small vessel occlusion and syphilis in patients with first-ever ischemic stroke

Sífilis ocular como manifestación de neurolues. A propósito de un caso clínico.

Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging

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