Pontine Pure Motor Hemiparesis due to Meningovascular Syphilis in Human Immunodeficiency Virus-Positive Patients

The Changing Face of Neurosyphilis

“…Meningovascular syphilis may affect the anterior or posterior circulation (9, 16), although the anterior circulation is more often involved (9, 17). Several brainstem syndromes attributed to neurosyphilis have been reported (18–20). Our patient had involvement of the anterior and posterior circulation and had persistence of basilar artery stenosis on follow-up.…”

The Changing Face of Neurosyphilis

“…Meningovascular syphilis may affect the anterior or posterior circulation (9, 16), although the anterior circulation is more often involved (9, 17). Several brainstem syndromes attributed to neurosyphilis have been reported (18–20). Our patient had involvement of the anterior and posterior circulation and had persistence of basilar artery stenosis on follow-up.…”

New Concepts in Lacunar Stroke Etiology: The Constellation of Small-Vessel Arterial Disease

“…Infectious arteritis caused by neurolues [33, 34], neurocysticercosis [35], neuroborreliosis [36]or by AIDS [37]has also been associated with the presence of LI. In patients with first-ever stroke, chronic Helicobacter pylori infection detected by IgG antibodies was associated with a risk of small-artery occlusion [38].…”

Laboratory diagnosis and interpretation of tests for syphilis

“…Although most HIV-infected persons who also are infected with T. pallidum appear to respond normally in the serologic tests for syphilis and have typical clinical signs (63,169), several exceptions have been published (38,108,162) or reported to the CDC. The problems in the diagnosis of syphilis are (i) confusing clinical signs and symptoms (38,162); (ii) lack of serologic response in a patient with a clinically confirmed case of active syphilis (64,72); (iii) failure of nontreponemal test titers to decline after treatment with standard regimens; (iv) unusually high titers in nontreponemal tests (140), perhaps as the result of B-cell activation (107); (v) rapid progression to late stages of syphilis and neurologic involvement even after treatment of primary or secondary syphilis (6,50,91,98,120,140); and (vi) the disappearance of treponemal test reactivity over time (67). Whether these problems in the diagnosis of syphilis occur more frequently in HIV-seropositive persons than in HIVseronegative persons with syphilis is unclear (169,171).…”

“…The literature abounds with descriptions of syphilis in so-called late-stage forms in relatively young persons who are HIV seropositive (38,50,91,98,108,162), but neurologic symptoms may be present among patients with secondary syphilis who are HIV seronegative as well (133). One study (120) found indications of T. pallidum in the central nervous system of 40% of patients with early syphilis.…”

The Changing Face of Neurosyphilis

“…Meningovascular syphilis may affect the anterior or posterior circulation (9, 16), although the anterior circulation is more often involved (9, 17). Several brainstem syndromes attributed to neurosyphilis have been reported (18–20). Our patient had involvement of the anterior and posterior circulation and had persistence of basilar artery stenosis on follow-up.…”

New Concepts in Lacunar Stroke Etiology: The Constellation of Small-Vessel Arterial Disease

“…Infectious arteritis caused by neurolues [33, 34], neurocysticercosis [35], neuroborreliosis [36]or by AIDS [37]has also been associated with the presence of LI. In patients with first-ever stroke, chronic Helicobacter pylori infection detected by IgG antibodies was associated with a risk of small-artery occlusion [38].…”

Laboratory diagnosis and interpretation of tests for syphilis

“…Although most HIV-infected persons who also are infected with T. pallidum appear to respond normally in the serologic tests for syphilis and have typical clinical signs (63,169), several exceptions have been published (38,108,162) or reported to the CDC. The problems in the diagnosis of syphilis are (i) confusing clinical signs and symptoms (38,162); (ii) lack of serologic response in a patient with a clinically confirmed case of active syphilis (64,72); (iii) failure of nontreponemal test titers to decline after treatment with standard regimens; (iv) unusually high titers in nontreponemal tests (140), perhaps as the result of B-cell activation (107); (v) rapid progression to late stages of syphilis and neurologic involvement even after treatment of primary or secondary syphilis (6,50,91,98,120,140); and (vi) the disappearance of treponemal test reactivity over time (67). Whether these problems in the diagnosis of syphilis occur more frequently in HIV-seropositive persons than in HIVseronegative persons with syphilis is unclear (169,171).…”

“…The literature abounds with descriptions of syphilis in so-called late-stage forms in relatively young persons who are HIV seropositive (38,50,91,98,108,162), but neurologic symptoms may be present among patients with secondary syphilis who are HIV seronegative as well (133). One study (120) found indications of T. pallidum in the central nervous system of 40% of patients with early syphilis.…”

The Changing Face of Neurosyphilis

“…Meningovascular syphilis may affect the anterior or posterior circulation (9, 16), although the anterior circulation is more often involved (9, 17). Several brainstem syndromes attributed to neurosyphilis have been reported (18–20). Our patient had involvement of the anterior and posterior circulation and had persistence of basilar artery stenosis on follow-up.…”

New Concepts in Lacunar Stroke Etiology: The Constellation of Small-Vessel Arterial Disease

“…Infectious arteritis caused by neurolues [33, 34], neurocysticercosis [35], neuroborreliosis [36]or by AIDS [37]has also been associated with the presence of LI. In patients with first-ever stroke, chronic Helicobacter pylori infection detected by IgG antibodies was associated with a risk of small-artery occlusion [38].…”

Laboratory diagnosis and interpretation of tests for syphilis

“…Although most HIV-infected persons who also are infected with T. pallidum appear to respond normally in the serologic tests for syphilis and have typical clinical signs (63,169), several exceptions have been published (38,108,162) or reported to the CDC. The problems in the diagnosis of syphilis are (i) confusing clinical signs and symptoms (38,162); (ii) lack of serologic response in a patient with a clinically confirmed case of active syphilis (64,72); (iii) failure of nontreponemal test titers to decline after treatment with standard regimens; (iv) unusually high titers in nontreponemal tests (140), perhaps as the result of B-cell activation (107); (v) rapid progression to late stages of syphilis and neurologic involvement even after treatment of primary or secondary syphilis (6,50,91,98,120,140); and (vi) the disappearance of treponemal test reactivity over time (67). Whether these problems in the diagnosis of syphilis occur more frequently in HIV-seropositive persons than in HIVseronegative persons with syphilis is unclear (169,171).…”

“…The literature abounds with descriptions of syphilis in so-called late-stage forms in relatively young persons who are HIV seropositive (38,50,91,98,108,162), but neurologic symptoms may be present among patients with secondary syphilis who are HIV seronegative as well (133). One study (120) found indications of T. pallidum in the central nervous system of 40% of patients with early syphilis.…”