Abstract Details

Title High-Resolution Vessel Wall Imaging in Meningiovascular Neurosyphilis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 213

Objective NA

Background

High resolution vessel wall imaging (HR-VWI) is an emerging non-invasive tool for detecting intracranial vessel wall inflammation. We report a case of meningovascular neurosyphilis presenting with vertebral artery dissection (VA), illustrated by concentric contrast enhancement on HR-VWI.

Design/Methods NA

Results 32-year-old man with history of untreated HIV and polysubstance abuse presented with sudden onset vertigo for one day. He had persistent somnolence, severe dysarthria, alogia, bilateral pinpoint pupils, right eye exotropia and an upper motor neuron pattern right facial droop. Neuroimaging revealed that he had an occluded non-dominant left extracranial vertebral artery, with multifocal areas of irregularities on CT angiogram of the head and neck. Non-contrast brain MRI demonstrated multiple small acute infarcts in the left cerebellum, left brachium pontis, medulla and occipital lobe. Rapid plasma reagin was reactive (titer 256), HIV viral load 107 copies/mL, CD4 count 564 cells/mm3 and CD8 count 758 cells/mm3. 3D whole-brain HR-VWI reveled concentric vessel wall contrast enhancement in the V4 segment of left VA. The HR-VWI findings prompted further investigation which included a lumbar puncture and cerebrospinal fluid analysis. The CSF analysis showed pleocytosis of 2 cells/mm3, proteins 70mg/dL, normal glucose and reactive fluorescent treponemal antibody absorption test. The patient received intravenous Penicillin G course for 10 days (24 million units/day) and restarted on highly active antiretroviral therapy. His neurological symptoms improved, and the patient was discharged without residual deficits.

Conclusions Meningovascular neurosyphilis is a common cause of stroke in young adults, particularly when HIV co-infection is present. In our case, HR-VWI demonstrated VA concentric vessel wall enhancement, suggesting an active inflammatory process causing the VA irregularities seen on CT angiogram and leading to the final diagnosis. With high spatial resolution and signal-to-noise ratio, HR-VWI allows for early vessel wall inflammation visualization and monitoring the response to targeted antibiotic/anti-inflammatory therapy in co-morbid HIV-neurosyphilis.

Authors/Disclosures
Mohammad N. Kayyali, MD PRESENTER	Dr. Kayyali has nothing to disclose.
Austin T. Momii, MD	Dr. Momii has nothing to disclose.
	No disclosure on file
	No disclosure on file
Oana M. Dumitrascu, MD, F�鶹��ýӳ�� (Mayo Clinic)	Dr. Dumitrascu has nothing to disclose.

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