Meningovascular syphilis causing recurrent stroke and diagnostic difficulties: a scourge from the past.
We describe a case of a 49-year-old man who presented with recurrent strokes in the left middle cerebral artery territory, manifesting with dysphasia, higher cognitive deficits, motor deficits and subsequent infarcts in the right middle cerebral and anterior cerebral artery territories, manifesting with seizures, behavioural and social issues. A key issue of the case was the diagnostic difficulty faced by the physicians. 'Meningovascular syphilis' was subsequently confirmed and appropriate treatment was given but there was subsequent relapse with worsening of the symptoms. Multiple specialists were involved in the management, namely stroke team, neurologists, psychiatrists, infectious disease and multidisciplinary therapy teams. This case highlights the need to be vigilant to the resurgence of syphilis, a scourge from the past, as a cause of stroke, especially in individuals who have had exposure to affected people. It is easy to miss the diagnosis and mistake it for other conditions unless a detailed history is taken and appropriate investigations are conducted, with a low threshold for diagnosis.
['Munshi|Sunil|S|', 'Raghunathan|Senthil K|SK|', 'Lindeman|Ileana|I|', 'Shetty|Ashit K|AK|']
D000900:Anti-Bacterial Agents D003937:Diagnosis, Differential D019468:Disease Management D006801:Humans D018810:Magnetic Resonance Angiography D008297:Male D008875:Middle Aged D009494:Neurosyphilis D012008:Recurrence D020521:Stroke D000071939:Stroke Rehabilitation D014210:Treponema pallidum
syphilis stroke infection (neurology)