Neurosyphilis presenting as parkinsonism

McAuley, John; Hughes, Gaenor

doi:10.1136/bcr-2015-210277

Cited by 10 publications

(7 citation statements)

References 16 publications

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“…Vascular involvement leads to large vessel ischaemic strokes, particularly involving the middle cerebral artery 5. Multiple infarcts may eventually lead to vascular cognitive impairment and parkinsonism 6. Our patient uniquely exhibited a pure cerebellar syndrome.…”

Section: Discussionmentioning

confidence: 69%

Neurosyphilis presenting as pure cerebellar ataxia: an atypical manifestation

Garg

Vibha²,

Pandit

et al. 2019

BMJ Case Rep

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Neurosyphilis has become an uncommon diagnosis in the current era. Neurological manifestations of syphilis usually lie within the spectrum of meningovascular syphilis, tabes dorsalis or general paresis of the insane. Although sensory ataxia may occur as part of spinal cord involvement, cerebellar ataxia has been rarely described as a manifestation of neurosyphilis. In this report, we describe a rare case neurosyphilis presenting in the form of a pure pancerebellar syndrome of subacute progression.

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Section: Discussionmentioning

confidence: 69%

Neurosyphilis presenting as pure cerebellar ataxia: an atypical manifestation

Garg

Vibha²,

Pandit

et al. 2019

BMJ Case Rep

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“…However, the dramatic clinical improvement of our patient’s cognitive and behavioral disorders after therapy supports neurosyphilis as the main cause of his cognitive, psychiatric, and behavioral impairments. In addition, his clinical phenotype remained stable for >2 years, and his parkinsonism, which was probably attributable to basal ganglia involvement, also improved after doxycycline therapy (McAuley and Hughes, 2015).…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis Mimicking Behavioral Variant of Frontotemporal Dementia in a 59-Year-Old Man

Caroppo

Villa

Sole

et al. 2022

Cognitive and Behavioral Neurology

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We present the case of a man exhibiting a clinical phenotype of behavioral variant of frontotemporal dementia (bvFTD). The man had developed psychiatric disturbances with verbal aggressiveness over a few months, followed by cognitive and frontal behavioral disorders, fulfilling the clinical criteria for bvFTD. Atrophy and hypometabolism in frontotemporal regions were consistent with the diagnosis. However, serum-screening exams for syphilis infection were positive, and CSF analysis, despite a negative Venereal Disease Research Laboratory Test, suggested the diagnosis of neurosyphilis. After specific antibiotic therapy, the man’s behavioral abnormalities and cognitive deficits notably improved, confirming neurosyphilis as the cause of the clinical phenotype. The cognitive deficits completely recovered 1 year post therapy and remained stable for 2 years. After ∼2½ years from the first treatment, the man’s behavioral disorders mildly worsened, at which time we re-evaluated him. His cognition was stable, and a positive Venereal Disease Research Laboratory Test confirmed the diagnosis of neurosyphilis. With this case, we demonstrated that in some instances, neurosyphilis can mimic frontotemporal dementia. As a cause of treatable dementia, it should be considered in the differential diagnosis of bvFTD, particularly when psychiatric symptoms and a rapid cognitive decline are noted, even in the presence of brain atrophy and/or hypometabolism.

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“…There have also been recent cases reported of neurosyphilis presenting with confusion, psychotic symptoms, personality changes, and Parkinsonism. 10,[13][14][15][16][17] It is important to document these cases in the literature so that clinicians are aware of the myriad of ways in which neurosyphilis can present and they can recognise that it should always be considered as a differential diagnosis in young patients with unexplained neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis: An Important Cause of Recurrent Strokes

2017

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Background: Neurosyphilis can manifest as recurrent brain infarction, although not frequently, but can be challenging to diagnose due to atypical presentations. Case report: A 43-year-old male with history of smoking presented to the Midland Regional Hospital, Tullamore (MRHT), Offaly, Ireland, with focal speech deficit and arm/leg weakness for 3 days. Neuroimaging showed acute cerebral infarction. He denied any high-risk sexual contacts. Forty-eight hour telemetry, trans-thoracic echocardiogram, cerebral catheter angiogram, and magnetic resonance angiogram were normal. He was treated with high-dose aspirin for 14 days and then discharged on aspirin with a follow-up plan. Trans-oesophageal echocardiogram performed after 2 weeks showed no evidence of subacute bacterial endocarditis, but there was evidence of fibroelastoma on the aortic valve. The cardiology department felt this was not a likely cardioembolic source. The patient presented 2 months later with recurrent stroke symptoms of loss of speech to another hospital. However, he was discharged for follow-up in MRHT as symptoms resolved. Brain computed tomography (CT) showed ‘old’ stroke. One week later he re-presented to MRHT with dysarthria, ataxia, and a National Institute of Health Stroke Scale (NIHSS) score of three. Repeated neuroimaging showed multiple ‘new’ and ‘old’ cerebral infarcts. The patient was anticoagulated based on recurrent thromboembolic events and magnetic resonance imaging was repeated. CT aortogram and 48-hour Holter results were normal. A repeated magnetic resonance angiogram showed multiple stenosis areas due to vasculitis. As aetiology was complex, a lumbar puncture was performed and blood tests repeated (viral serology, vasculitic and thrombophilia screens). Cerebrospinal fluid and serum analysis displayed a diagnosis of neurosyphilis with co-infection of HIV. Treatment with penicillin was commenced, after which the patient greatly improved and is now under long-term follow-up. Conclusion: Stroke in a young patient is rare and recurrent stroke-like events in a young person raise the clinical suspicion of an alternative diagnosis. It is therefore imperative to investigate neurosyphilis in all HIV-positive patients, as it can cause early clinical manifestation in such patients.

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Neurosyphilis presenting as parkinsonism

Cited by 10 publications

References 16 publications

Neurosyphilis presenting as pure cerebellar ataxia: an atypical manifestation

Neurosyphilis presenting as pure cerebellar ataxia: an atypical manifestation

Neurosyphilis Mimicking Behavioral Variant of Frontotemporal Dementia in a 59-Year-Old Man

Neurosyphilis: An Important Cause of Recurrent Strokes

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