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Meningovascular Syphilis

Meningovascular Neurosyphilis


Presentation

  • The presentation, evolution, and treatment of this unusual form of vascular syphilis are discussed.[ncbi.nlm.nih.gov]
  • Meningovascular syphilis presents as a subacute encephalitic syndrome with superimposed cerebrovascular events that may evolve gradually. This picture differs from the more common cases of thrombotic or embolic stroke.[ncbi.nlm.nih.gov]
  • Acute syphilitic transverse myelitis: unusual presentation of meningovascular syphilis. Abstract A case of meningovascular syphilis presenting with the rare spinal cord manifestations is reported.[sti.bmj.com]
  • A 35-year-old man without any known medical history presented with an acute ischemic stroke and was initially treated with intravenous tissue plasminogen activator.[ncbi.nlm.nih.gov]
  • A man aged 31 presented to hospital with acute onset of weakness in the legs, sensory loss, and disturbance of bladder and bowel function.[ncbi.nlm.nih.gov]
Prostitute
  • He gave history of a genital sore' 7 years back, that developed following an unprotected sexual intercourse with a prostitute. It healed spontaneously in 5 weeks.[ijdvl.com]
  • The Communist party cracked down on prostitution as well, which resulted in a near elimination of syphilis [2].[microbewiki.kenyon.edu]
  • Drug usage, active male homosexuality, unprotected sex, and prostitution are all contributing to the rise in early syphilis and thus the increased incidence of neurosyphilis.[priory.com]
Vomiting
  • , headache. 03:55 And sometimes the vomiting is projectile, sort of effortless vomiting. 04:02 That's a sign of increased intracranial pressure. 04:06 Or they may have acute hydrocephalus without any focal signs. 04:11 And some patients may have meningitis[lecturio.com]
  • Along with this, there are bladder disorders, erectile dysfunction and delayed ejaculation in men, acute abdominal pain and vomiting (visceral crises).[minclinic.ru]
  • Jeerakathil CMAJ June 05, 2007 176 (12) 1699-1700; DOI: 2007 Canadian Medical Association Case 1: A previously healthy 51-year-old man came to hospital complaining of headache of 3 weeks' duration and several days of nausea, vomiting and confusion.[cmaj.ca]
  • He had previous flu-like syndrome with abdominal pain, vomiting and diarrhea for three days. The present symptoms started with slight weakness of bilateral legs after he was awake.[file.scirp.org]
  • […] conditions like; heart attack, obstruction to blood flow (ischemia, occlusion), and blood clot formations General Paresis of the Insane Tabes Dorsalis Optic Atrophy Tertiary Syphilis: Neurosyphilis – Meningovascular signs and symptoms include: Stroke Vomiting[dovemed.com]
Nausea
  • […] of syphilitic meningitis. 03:35 About 50% or more recall having had a chancre or some kind of rash that was consistent with secondary syphilis, or they may have had both. 03:47 The classic findings are signs of increased intracranial pressure such as nausea[lecturio.com]
  • Jeerakathil CMAJ June 05, 2007 176 (12) 1699-1700; DOI: 2007 Canadian Medical Association Case 1: A previously healthy 51-year-old man came to hospital complaining of headache of 3 weeks' duration and several days of nausea, vomiting and confusion.[cmaj.ca]
  • […] like; heart attack, obstruction to blood flow (ischemia, occlusion), and blood clot formations General Paresis of the Insane Tabes Dorsalis Optic Atrophy Tertiary Syphilis: Neurosyphilis – Meningovascular signs and symptoms include: Stroke Vomiting and nausea[dovemed.com]
  • DISCUSSION Symptomatic meningitis may occur years later, with headache and neck pain, confusion, nausea, vomiting, stiffness, seizures, decreased visual acuity, cranial neuropathies, cerebral arteritis, syphilitic leptomeningitis or gums causing back[revistanefrologia.com]
  • Symptoms include: nausea vomiting a stiff neck a headache It may also cause a loss of hearing or vision. Meningovascular neurosyphilis This is a more serious form of meningeal neurosyphilis. In this case, you would also have had at least one stroke.[healthline.com]
Bruxism
  • […] headaches; The neck and headaches; Drug-induced headaches; Trigeminal neuralgia and glossopharyngeal neuralgia; Headaches and vasculitis; Tonsilar ectopia and headaches; Post-traumatic headaches; Metabolic headaches; Temporomandibular joint disorders, bruxism[books.google.com]
Diplopia
  • Luxon et al describe patients presenting with diplopia due to sixth nerve palsy, deterioration of vision due to optic neuritis, primary optic atrophy or choroidoretinitis, and otological symptoms such as sudden deafness or repeated vertigo.[kraeplinpsychiatry.wordpress.com]
Vertical Gaze Palsy
  • The patient did not have any vertical gaze palsy, and his pupil reaction to light and accommodation were intact bilaterally. The remainder of the examination was normal. The sensory and coordination tests were not accurately evaluated.[file.scirp.org]
Neurogenic Arthropathy
  • Neurogenic arthropathy (Charcot joints), a painless joint degeneration with bony swelling and abnormal range of movement, is a classic manifestation of neuropathy.[merckmanuals.com]
Osteophyte
  • […] meningomylocele, diastematomyelia, sacralization, lumbarization, spondylolisthesis) Spinal cord compression Spinal cord diseases Spinal cord and spinal canal epidural space hemangiomas Spinal cord infarction (ischemic stroke) Spinal stenosis, lumbar and cervical osteophytes[minclinic.ru]
Headache
  • ; Headaches and vasculitis; Tonsilar ectopia and headaches; Post-traumatic headaches; Metabolic headaches; Temporomandibular joint disorders, bruxism, and headaches.[books.google.com]
  • The combination of prominent and persistent headaches and stroke may suggest meningovascular syphilis even in the absence of meningism.[cmaj.ca]
  • The infection has symptom headache, has symptom neck stiffness, has symptom dizziness, has symptom behavioral abnormalities, has symptom poor concentration, has symptom memory loss, has symptom lassitude, has symptom insomnia, has symptom blurred vision[malacards.org]
  • Early chapters present differential diagnosis and management approaches to common overarching problems such as coma, headache, and elevated intracranial pressure, followed by chapters focusing on the evaluation and management of specific conditions including[books.google.com]
  • However, about 50% of patients have premonitory symptoms of headache, dizziness, insomnia, memory loss, or mood disturbances lasting for weeks or months, probably consistent with diffuse arterial involvement.[std-aid.com]
Personality Change
  • When there is focal inflammation the clinical picture is characterized by hemiplegia, whereas in the case of multifocal involvement of small intracranial arteries, it presents with a slowly progressive loss of cognitive functioning and personality changes[karger.com]
  • Other complicated symptoms in neurosyphilis include personality change (33%), ataxia (28%), and stroke (23%) [13]. Disease may occur in the early post-primary stage or after a gap of many years.[file.scirp.org]
  • changes 4 occurs years to decades after infection 3,4 tabes dorsalis presents with symptoms related to dorsal column and dorsal root involvement such as sensory ataxia (tabetic gait), lancinating neuropathic pains, and urinary incontinence 4 many patients[radiopaedia.org]
  • A subacute encephalitic prodrome is present, characterized by the presence of headaches, vertigo, insomnia, and psychological abnormalities such as personality change, emotional lability, insomnia, decreased memory. Fig. 2.[atlasofscience.org]
Dizziness
  • The infection has symptom headache, has symptom neck stiffness, has symptom dizziness, has symptom behavioral abnormalities, has symptom poor concentration, has symptom memory loss, has symptom lassitude, has symptom insomnia, has symptom blurred vision[malacards.org]
  • His chief complaints were double vision and dizziness, with mild exodeviation in both eyes in primary gaze position in the ocular motility examination, but more predominant in the left eye.[elsevier.es]
  • However, about 50% of patients have premonitory symptoms of headache, dizziness, insomnia, memory loss, or mood disturbances lasting for weeks or months, probably consistent with diffuse arterial involvement.[std-aid.com]
Dysarthria
  • Later, by afternoon there were progressive neurological symptoms such as dysarthria and clumsiness of both hands. Within hours, his level of consciousness worsened progressively, and he became quadriparetic.[file.scirp.org]
  • General paresis is characterized by progressive DEMENTIA; DYSARTHRIA; TREMOR; MYOCLONUS; SEIZURES; and Argyll-Robertson pupils.[fpnotebook.com]
  • Pupillary abnormalities, tremor and dysarthria head the list of abnormal findings. The pupils Tremor Dysarthria Reflex abnormalities Incoordmation is seen in the clumsiness of the hands and the characteristic slouching, unsteady gait.[kraeplinpsychiatry.wordpress.com]
  • Case 1 A 69-year-old man, born in Ethiopia, suffering of type II DM, hyperlipidemia and hypertension, presented to the ER with right mild hemiparesis and dysarthria that started 3 hours before his arrival.[omicsonline.org]
Cranial Nerve Involvement
  • Cranial nerve involvement can result in hearing loss, facial weakness, or visual disturbances. Syphilis can also affect the spinal cord, causing meningomyelitis.[health.am]
  • The clinical syndromes included focal neurological manifestations such as cranial nerve involvement and including range of manifestations including meningitis, meningovascular syphilis, tabes dorsalis and dementia ( Table 1 ).[journals.plos.org]
  • Cranial nerve involvement, particularly the optic and vestibulocochlear nerves, has been reported. With chorioretinitis, orbital MRI would likely show nerve sheath enlargement.[emedicine.medscape.com]

Workup

  • Nontreponemal syphilis screening tests such as the rapid plasmin reagin test should be reincorporated into the diagnostic workup of any young patient with stroke and all patients with stroke who have the historical or clinical features outlined.[cmaj.ca]
  • Because the face of syphilis within the dominion of neurology has changed tremendously over the years and as screening tests for syphilis are increasingly becoming routine components of acute stroke laboratory workup (especially in younger patients),[practicalneurology.com]
  • […] reliable, inferior altitudinal defect, enlargement of the blind spot OS: reliable, normal Laboratory testing September 2016 RPR 1:2 FTA ABS CSF 5 cells, protein 30, Glucose 191 (serum 298) CSF VDRL negative HIV negative Additional infectious/inflammatory workup[eyewiki.aao.org]
  • Neurosyphilis is a treatable cause of dementia and movement disorders, and the disorder must be considered as a possible diagnosis in the routine workup of patients with cognitive decline and movement disorders.[bmcresnotes.biomedcentral.com]
  • Muscle weakness Upon further diagnostic workup, the following signs may be present: Abnormal reflexes Muscle atrophy Muscle contractions Approximately 35% to 40% of persons with secondary syphilis have asymptomatic central nervous system (CNS) involvement[psychology.wikia.com]
Cerebrospinal Fluid Abnormality
  • Interesting correlations were found in relation to the cerebrospinal fluid abnormalities at the time of treatment.[kraeplinpsychiatry.wordpress.com]
  • There are no established guidelines for the appropriate rate of resolution of cerebrospinal fluid abnormalities in patients with neurosyphilis.[nejm.org]
  • Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory Features. J Infect Dis. 2004;189: 369–376. pmid:14745693 View Article PubMed/NCBI Google Scholar 15. Wolf B, Kalangu K.[journals.plos.org]

Treatment

  • Despite initial successful recanalization, he suffered recurrent vertebrobasilar occlusion, and a second endovascular treatment attempt was unsuccessful.[ncbi.nlm.nih.gov]
  • Meningovascular syphilis developed in a patient two years after the treatment of primary syphilis with a single intramuscular injection of 2.4 million units of penicillin G benzathine as recommended by the Centers for Disease Control.[ncbi.nlm.nih.gov]
  • Although rare, because of the high impact on treatment, clinicians should always be aware of meningovascular syphilis in the differential diagnosis of stroke, particularly in young and male patients with cryptogenic stroke.[ncbi.nlm.nih.gov]
  • Optimal treatment is uncertain, and requires monitoring of spinal fluid abnormalities until they return to normal.[ncbi.nlm.nih.gov]
  • Magnetic resonance imaging (MRI) disclosed a large lesion of the midbrain and thalamus with intense enhancement of the interpeduncular cistern, both of which resolved after treatment with intravenous penicillin.[ncbi.nlm.nih.gov]

Prognosis

  • The rapid identification of the pathology contributed to the better prognosis of the patient.[elsevier.es]
  • […] bacteria) Excessive craving for drugs and alcohol, may lead to unsafe practices, such as ‘sex for drugs’ If you are frequently sexually active with multiple partners; then regular screening for sexually transmitted diseases is essential What is the Prognosis[dovemed.com]
  • Prognosis is generally good unless there are established non-reversible changes such as cerebral infarction or atrophy 1,10 .[radiopaedia.org]

Etiology

  • Although the radiologic findings are nonspecific, the diagnosis of meningovascular syphilis should be considered in patients with vasculitis of uncertain etiology.[ncbi.nlm.nih.gov]
  • Although the radiologic findings are nonspecific, the diagnosis of meningovascular syphilis should be considered in patients with vasculitis of uncertain etiology. Article History Published in print: 1986[pubs.rsna.org]
  • The secondary headaches include a diverse and fascinating array of etiologies which can mimic primary headache disorders ranging from the rare to the mundane and from the well established to the highly controversial.[books.google.com]
  • (Etiology) Syphilis is a contagious bacterial infection that is transmitted through sex with an affected individual.[dovemed.com]
  • Etiology Treponema bacteria (particularly during stages I/II) are highly contagious! Sexual contact with a partner who suffers from active syphilis will lead to infection in 30% of cases![amboss.com]

Epidemiology

  • It thus requires further studies of the epidemiology and treatment of these STD co-infected young meningovascular disease.[file.scirp.org]
  • Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Treponema bacteria (particularly during stages I/II) are highly contagious![amboss.com]
  • Epidemiology Treponema pallidum , the causative agent of syphilis, belongs to the family Spirochaetaceae and is a unicellular, spiral organism that cannot be cultivated in vitro.[pedsinreview.aappublications.org]
  • Epidemiology, treatment and molecular typing of Treponema pallidum. Dan Med J. 2015 Dec;62(12):B[emdocs.net]
  • Our data suggest that neuosyphilis remains an important disease in Africa but better prospective studies are needed to understand its epidemiology.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • Get a quick and memorable overview of anatomy, pathophysiology, and clinical presentation from the precision and beauty of Netter and Netter-style plates that highlight key neuroanatomical and neurologic concepts.[books.google.com]
  • References: [3] [4] Pathophysiology Clinical features Primary syphilis Primary lesion ( chancre ) Typically starts out as a solitary, raised papule (usually on the genitals) Evolves into painle ss, firm ulcer with indurated borde rs and smooth base Resolves[amboss.com]
  • (serum 298) CSF VDRL negative HIV negative Additional infectious/inflammatory workup negative History In 2011 the patient had tested positive for a “venereal disease” and was treated with 2-3 intramuscular injections Ocular syphilis (Neurosyphilis) Pathophysiology[eyewiki.aao.org]
  • Pathophysiology The disease syphilis was reported in the medical literature as early as 1495. In the treatment of syphilis. heavy metals, such as arsenic, were replaced by penicillin 1940.[labpedia.net]
  • This inflammation of the membranes causes meningitis. [7] Pathophysiology [ edit ] Autopsy of Brain with Meningitis Syphilis is a sexually transmitted disease that is brought upon by the gram negative bacteria, Treponema pallidum.[en.wikipedia.org]

Prevention

  • Chapter 69 Surrogate Markers of Antiretroviral Efficacy 826 Overcoming Barriers to Providing ARV Therapy in ResourceLimited Settings 831 Chapter 71 Antiretroviral Drugs for HIV Prevention 836 Chapter 72 Acute HIV Infection 843 Chapter 73 Opportunistic[books.google.com]
  • They have to be also aware of the preventive measures and precautions to be taken, which include: Avoidance of multiple sex partners Practice of safe sex (use of condoms that prevent entry of the syphilis bacteria) Excessive craving for drugs and alcohol[dovemed.com]
  • The conclusion is that NS is a disease that still prevails and that appropriate diagnosis and treatment prevent irreversible neurological sequelae. Biblioteca responsável: CL1.1[pesquisa.bvsalud.org]
  • […] of HIV HIV Transmission and Prevention in Specific Populations Systematic Review of HIV Behavioral Prevention Research in African Americans Lynae A.[hivinsite.ucsf.edu]
  • "A Brief Introduction to the National Center for AIDS Prevention and Control, China CDC." National Center for AIDS/STD Control and Prevention, China CDC. NCAIDS. 26 Aug 2009 . [12]. "Prevention and Treatment of Infectious Diseases."[microbewiki.kenyon.edu]

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