Premium
Trancranial Doppler Monitoring of Response to Therapy for Meningovascular Syphilis
Author(s) -
Kelley Roger E.,
Minagar Alireza,
Kelley Bradford J.,
Brunson Regina
Publication year - 2003
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2003.tb00163.x
Subject(s) - medicine , syphilis , neurosyphilis , middle cerebral artery , basilar artery , cerebrospinal fluid , transcranial doppler , central nervous system , penicillin , anterior cerebral artery , cerebral arteries , lesion , cardiology , human immunodeficiency virus (hiv) , surgery , antibiotics , ischemia , immunology , microbiology and biotechnology , biology
Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46‐year‐old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10‐day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4‐month follow‐up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.