Abstract Details

Title Neurosyphilis Presenting as Acute Ischemic Stroke and Improvement with Thrombolytics

Topic Infectious Disease

Presentation(s) Infectious Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 053

Objective We present a rare case of neurosyphilis presenting with acute ischemic stroke, who received intravenous tissue plasminogen activator (tPA).

Background Neurosyphilis is a central nervous system infection caused by Treponema pallidum and may occur at any stage of the disease. Neurosyphilis most commonly occurs in persons with HIV. Early forms occur within months to several years after infection; they include asymptomatic, meningeal and meningovascular neurosyphilis. Late forms occur several years after, and include general paresis and tabes dorsalis. Meningovascular neurosyphilis can have meningeal involvement, endarteritis leading to cerebral infarction, or a combination of both. Most commonly the middle cerebral artery is affected, with symptoms of hemiparesis, hemiplegia and aphasia. Diagnosis is based on clinical findings and CSF studies, with CSF-VDRL as the standard diagnostic test. Treatment consists of high-dose IV penicillin G for 10-14 days. Treatment response is monitored clinically and with nontreponemal testing.

Design/Methods Case Report.

Results A 39 year-old male with recently diagnosed HIV presented with right sided weakness and dysarthria. Non-contrast head CT was negative for hemorrhage and IV tPA was administered. CTA was negative for large vessel occlusion or stenosis. MRI brain demonstrated acute infarcts in the left internal capsule and globus pallidus and remote right parietal lobe infarct. CD4 count was consistent with advanced AIDS and serum RPR confirmed systemic syphilis. CSF studies showed elevated WBC, protein and positive VDRL; consistent with neurosyphilis. The patient was started on a continuous penicillin infusion; upon completion, antiretroviral therapies were initiated. Aspirin was started for secondary stroke prevention. The patient’s right hemiparesis improved over the course of his admission.

Conclusions We must consider meningovascular neurosyphilis as a cause of stroke in immunocompromised patients, particularly those with HIV. These patients may benefit with thrombolytic intervention. If left untreated, neurosyphilis can progress to dementia, paralysis and death.

Authors/Disclosures
Monica Sarkar, MD PRESENTER	Dr. Sarkar has nothing to disclose.
Gaurav Thakur, DO	Dr. Thakur has nothing to disclose.
Lindsay A. Bliss, DO (Bronson Hospital)	Dr. Bliss has nothing to disclose.
Adnan Safdar, MD (Ohio State University-Wexner Medical Center Neurovascular Stroke Center)	Dr. Safdar has nothing to disclose.

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Abstract Details