Neurosyphilis presents with 4 different clinical forms: Asymptomatic (most frequent), meningeal, meningovascular
and parenchymal forms (2).
His subsequent positive CSF VDRL confirms the diagnosis of neurosyphilis, while his cerebrovascular imaging was consistent with that of vasculitis, leading to the diagnosis of ischemic stroke secondary to meningovascular
Stages of neurosyphilis Stage Symptoms Asymptomatic None Symptomatic Early Meningeal Meningovascular
Late Gummatous Cerebral Spinal compression Parenchymatous General paresis Tabes dorsalis Optic atrophy Table 2.
How HIV may affect the course and treatment of syphilis * Higher RPR or T pallidum hemagglutination assay titer * False-negative syphilis serology * More frequent prozone phenomenon (* 68) * Higher rate of asymptomatic primary syphilis (66-68) * Multiple or deeper chancres during primary syphilis (69) * Overlap of primary- and secondary-stage features of syphilis (66,68) * Shorter latency period before meningovascular
syphilis * Increased rate of early neurologic and ophthalmic involvement (66,68) * More rapid progression to tertiary manifestations (69) * Reduced efficacy of standard therapy for early syphilis ([dagger] 66) * More frequent relapse ([dagger] 68,70) * Delayed normalization of CSF values after treatment (69) Adapted from Pialoux et al.
Experience of meningovascular
syphilis in human immunodeficiency virus infected patient.
Within five to ten years of an untreated initial infection, patients can develop meningovascular
To the best of our knowledge, only 3 cases of medial or mediolateral medullary infarction and the classic clinical features of central Tapia syndrome have been described during the past century; 2 of these patients had brainstem infarctions, and 1 had meningovascular
The first group had meningovascular
complications as prominent signs.
syphilis occurs due to involvement of blood vessels in the subarachnoid space resulting in arteritis, leading to thrombosis, infarction and ischemia.
Widespread vasculitis may be a feature of secondary syphilis, presenting with syndromes including hepatitis, iritis, stroke and meningovascular