Open AccessNeurosyphilis causing stroke in young adult: a case report
Author(s) -
Victoria Veiga Ribeiro Gonçalves,
Isabela Fonseca Risso,
Pedro Vinícius Brito Alves,
Guilherme Diogo Silva,
Juscélia Cristina Pereira,
Coralia Gabrielle Vieira Silveira,
Paula Baleeiro Rodrigues Silva,
Paulo Eduardo Lahoz Fernandez,
Ingrid Caroline Freitas Barboza,
Tarso Adoni,
Eduardo Genaro Mutareli
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.127
Subject(s) - neurosyphilis , medicine , syphilis , stroke (engine) , pediatrics , basilar artery , stenosis , ataxia , neurology , surgery , immunology , psychiatry , mechanical engineering , human immunodeficiency virus (hiv) , engineering
Up to 10% of strokes affect people under 45 years old. Syphilis is most common in adults. Fourteen percent of neurosyphilis cases have stroke its first manifestation. Objectives: To discuss neurosyphilis as an overlooked etiology for stroke. Design and setting: The case occurred in a public secondary care hospital located in São Paulo - Brazil. Methods: We present a case report of a 28-year-old woman brought to the emergency department due to acute ataxia. Previous history shows stroke at the age of 20 years old. Brain MRI showed ischemia in both cerebellar hemispheres, pons and midbrain. Arterial angiography showed segmental basilar artery stenosis. Serum laboratory tests showed Venereal Disease Research Laboratory (VDRL) of 1:128. Cerebrospinal fluid (CSF) analysis showed 117 cells (predominantly lymphomononuclear), protein 81 mg/ dl, normal glucose and VDRL of 1:8, confirming neurosyphilis. Treatment with intravenous penicillin led to partial improvement in ataxia before discharge. Discusion: A high percentage (up to 80%) of diagnostical errors is expected when stroke is caused by neurosyphilis. Misdiagnosis may compromise secondary prevention. It is possible that the first stroke was also caused by neurosyphilis in our patient. The involvement of the vertebrobasilar territory occurs in 25% of patients with meningovascular neurosyphilis. Basilar stenosis is typical for neurosyphilis. Conclusion: Stroke in young adults should include VDRL to screen for neurosyphilis. If positive, it should indicate a CSF exam.