Syphilis detection in cerebrovascular disease.

Abstract

To determine the importance of syphilis testing in cerebrovascular disease, we prospectively assessed 218 consecutive patients with either transient ischemic attack or completed stroke. The results from this study group were compared with those from a control group of 150 neurological patients without cerebrovascular disease. Of 275 patients from both groups specifically tested by the fluorescent treponemal antibody-absorption test, 34% of the study group were seropositive compared with 18% of the controls (^2=7.7, p<0.01). Fifty-four percent of the patients with a positive fluorescent treponemal antibody-absorption test underwent a cerebrospinal fluid examination; meningovascular syphilis was detected in one (0.4%) of these. This patient was a homosexual male with antibodies to the human immunodeficiency virus; a second patient, with possible meningovascular syphilis, also had antibodies to this virus. Despite the relatively high rate of syphilis seropositivity noted in our study group, syphilis was not found to be a common cause of cerebrovascular disease; therefore, routine screening is seen to be of low diagnostic yield. Attention to patients who are at higher risk for syphilitic infection, patients with clinical features suggestive of meningovascular syphilis, and the proper choice of serologic studies can help make the assessment of syphilis seropositivity more clinically appropriate and cost effective. T his study was undertaken to assess the value of testing for syphilitic infection in patients admitted to the hospital with a diagnosis of stroke or transient ischemic attack (TIA) in the 1980s. We have observed that screening for meningovascular syphilis is still done routinely in patients presenting with cerebrovascular disease (CVD) despite the apparent low yield. We thus prospectively assessed the pattern of testing and the results at a large, urban, university-affiliated hospital in Miami, Florida. These results were compared with those from a control group of patients who underwent syphilis screening because of neurologic disorders other than CVD. Subjects and MethodsConsecutive patients with stroke or TIA were assessed prospectively on the Neurology Service at Jackson Memorial Hospital, Miami, Florida, from July 1, 1986, through December 31, 1986. A total of 218 patients were entered, and each patient was screened for syphilis infection by history, review of previous medical records, and examination. These CVD patients were compared with 150 control patients, chosen at random from medical records, Received May 2, 1988; accepted July 26, 1988. who were admitted to the Neurology Service over the same time period, had a neurologic disorder other than CVD, and had had at least one screening test for syphilis. The tests for syphilis included the rapid plasma reagin (RPR), which is a simplified version of the Venereal Disease Research Laboratory (VDRL) test, the serum fluorescent treponemal antibody-absorption (FTA-ABS) test, and the cerebrospinal fluid VDRL (CSF VDRL). The performance and choice of a ...

Assessment and Investigation of Stroke and Transient Ischaemic Attack

“…Table 2 does not include either syphilis serology or routine chest radiography. Kelley and colleagues reported that even though screening tests for syphilis may be positive the detection of unexpected meningovascular syphilis was very uncommon 30. A similar pattern was found in the Oxfordshire community stroke project.…”

Pure motor hemiparesis due to pontine infarction as the presenting sign of neurosyphilis

“…the subtle immunoglobulin abnormalities (OCBs and local IgG synthesis) still detectable in the post-treatment CSF probably do not correlate with the activity of the disease (Fishman, 1992). Although the importance of syphilis testing in cerebrovascular disease has recently been challenged (Kelley et al, 1989). this case emphasizes that the differential diagnosis of stroke in a young man must include syphilis (Johns er al.. 1987).…”

Cerebrovascular Complications of Neurosyphilis: The Return of an Old Problem

“…Syphilis has epidemic proportions in large urban areas on the East Coast of the United States. In Florida, the reported inci dence of syphilis in 1987 was 65.9 per 100,000 persons [8,9], particularly among homosexual men [10], in whom the incidence of primary and secondary syphilis and thus the onset of neurosyphilis has increased since 1985 [8,11], The rise in the incidence of syphilis in the United States is mainly related to an increase in the num ber of cases of cocaine/crack addiction. In 1988, 41% of women with syphilis in Connecticut reported cocaine use [12].…”