2024 Volume 46 Issue 2 Pages 149-156
Herein, we report a case of stroke with suspected meningovascular neurosyphilis. A 56-year-old man was brought to our hospital due to sudden weakness of the right upper limb and headache during a visit to a sex establishment. Computed tomography and magnetic resonance imaging showed a small amount of subarachnoid hemorrhage in the cerebral convexity and cerebral infarction in the left cerebral perforating branch region; various imaging studies showed stenotic changes in multiple regions of bilateral mainstem cerebral arteries. Blood samples upon admission were positive for syphilis, and cerebrospinal fluid (CSF) examination revealed an elevated cell count of 112/µl, protein levels of 95.0 mg/dl, treponema pallidum antibody level of 149.6 COI, and rapid plasma reagin (RPR) level of 10.6 RU. A diagnosis of meningovascular neurosyphilis was made. After intravenous penicillin infusion and steroid pulse therapy, the RPR level of CSF became negative at 0.1 COI and the stenotic lesion in the main cerebral arteries improved, and the patient was discharged home. Although meningovascular neurosyphilis with intracranial hemorrhage is a rare condition, the number of similar cases may increase as the number of patients with syphilis increases. It is important to distinguish this case from other diseases carefully and administer penicillin promptly.
