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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neurosyphilis, a sexually transmitted disease that can cause neurologic damage, has become increasingly prevalent in the AIDS era. HIV carriers can contract neurosyphilis without the presence of other concurrent opportunistic infections. Because MR findings of neurosyphilis are seldom reported, we retrospectively reviewed and evaluated contrast-enhanced MR images of six young (average age, 33 years) HIV-positive men with high serum and CSF VDRL titers indicative of neurosyphilis. All six patients tested negative for concurrent opportunistic infections. Five patients had acute or subacute strokelike symptoms involving the basal ganglia or middle cerebral arteries; one had a parietal convexity mass mimicking meningioma with headache and ataxia. Contrast-enhanced MR images showed patchy enhancement involving the basal ganglia and middle cerebral artery territories in the first five patients and the convexity mass in the sixth patient. On the basis of brain biopsy, a convexity mass was diagnosed in the patient with syphilitic gumma. The imaging findings of the remaining five patients represented ischemic infarct caused by meningovascular syphilis. After penicillin treatment, serum and CSF VDRL titers decreased, and neurologic signs and symptoms improved in all six patients. A follow-up MR study in the patient with the gumma showed that the lesion resolved almost completely. In young HIV patients with stroke symptoms or a convexity mass, neurosyphilis should be considered. Contrast-enhanced MR can reveal the extent of involvement by neurosyphilis and should be used to facilitate diagnosis and proper treatment.
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PMID:Neurosyphilis in HIV carriers: MR findings in six patients. 159 Jan 35

We describe four patients with cerebral infarction and active neurosyphilis who had variable angiographic findings. Patients 1 and 2 had evidence of arteritis and an atheromatous ulcerated stenosis of the extracranial carotid artery, respectively. The third and fourth patients had symptoms of lacunar infarction, but cerebral angiography was normal in patient 3, whereas patient 4 had evidence of concomitant atheromatous and arteritic lesions. Neither age nor presence of cerebrovascular risk factors was of aid in predicting angiographic features. The concomitance of cerebral infarction and active neurosyphilis does not imply a cause-and-effect relation, since atherosclerotic lesions may coexist with arteritis or may even represent the only angiographic feature. Our findings underscore the importance of angiography to confirm the diagnosis in cases of suspected syphilitic arteritis.
Stroke 1990 Feb
PMID:Variable angiographic findings in patients with stroke and neurosyphilis. 230 11

Computed tomography was performed and risk factors evaluated in 100 consecutive adult patients presenting to the two teaching hospitals in Harare with a clinical diagnosis of stroke. The mean age of the patients was 52; only 28 were 65 or older. Non-stroke lesions were found in seven patients and were predicted by a recent history of convulsions (p less than 0.0001). Five lesions (four subdural haematomas and one cerebral cysticercosis) were remediable. Hypertension was present in 27 (93%) of the 29 patients with cerebral haemorrhage and in 49 (53%) of the 93 patients with stroke lesions. In 22 (45%) of these patients the hypertension had not been diagnosed, and another 22 had defaulted from treatment. All 13 patients who died before computed tomography had hypertension, and over half showed evidence of haemorrhagic stroke. There was a cardiac source for all 12 cases of cerebral embolism. In eight of the 100 patients cerebral infarction was attributed to neurosyphilis. None of the patients had clinical evidence of atherosclerosis. Smoking and oral contraceptives did not seem important risk factors for stroke. Detection and control of hypertension remain the most important measures needed to reduce the incidence of and mortality from stroke in Zimbabwe.
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PMID:Strokes among black people in Harare, Zimbabwe: results of computed tomography and associated risk factors. 308 59

Among forty-six patients with neurosyphilis, seen over a ten-year period, six had features highly suggestive of syphilitic cerebral vascularitis. The carotid distribution was involved in five patients and the posterior cerebral artery in one. As exemplified by these six observations, syphilitic arteritis should be considered when an ischemic stroke occurs with no apparent etiology. The fluorescent treponemal antibody adsorbed test (FTA-ABS) in the cerebrospinal fluid is the most reliable and the most specific laboratory test for the diagnosis of neurosyphilis.
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PMID:[Neurosyphilitic arteritis. Clinical, paraclinical and therapeutic data. A review of six cases (author's transl)]. 628 87

A young man with a history of two strokes was found to have serologic evidence of a prior syphilitic infection, abnormal spinal fluid, and angiographic evidence of diffuse intracranial and extracranial angiopathy which we believe was due to tertiary syphilis, although his use of oral amphetamines cannot be ruled out as a contributing factor. This is the first reported case in which angiography has demonstrated both intracranial and extracranial disease arterial disease due to neurosyphilis. Since syphilis can produce diffuse cerebral arterial changes, this diagnosis should be considered in young patients with stroke even when non-treponemal serologic tests are negative.
Stroke
PMID:Angiographic findings in a young man with recurrent stroke and positive fluorescent treponemal antibody (FTA). 636 93

Mandurai City is a composite of many villages with a total population not exceeding one million. Undoubtedly more than 95% of the hospital patients come from the rural areas. Our Government Hospital is the largest and reflects the medical assistance provided for people of average and low income. In our experience, 15% of cerebrovascular strokes occur in those below 40 years of age. Meningovascular neurosyphilis in men (10-15%) and puerperal cerebral venous thrombosis in women (20%) were the two commonly proved causes. Haemorrhagic stroke was uncommon. Embolic strokes from rheumatic heart disease formed 10%. In over 50%, the cause of stroke was not clear. Among 150 patients with neurosyphilis, mostly men, 25 had cerebral arterial thrombosis with stroke syndrome. This study reports on 138 patients with cerebral venous thrombosis and 7 patients with arterial thrombosis in puerperium. Mortality was 20% and quality of survival was good. The incidence, clinical picture, and diagnostic investigations are discussed with a review of literature.
Stroke
PMID:Ischemic cerebrovascular disease in the young. Two common causes in India. 646 68

The incidence of neurosyphilis in the Greater Copenhagen region was found to be 0.30 per 100,000 inhabitants per year within a 5 year period. This figure is higher than incidence found in other studies from the last decades, but does not represent a statistically significant rise. Using hospital records from relevant departments 23 patients were described. General paresis and meningovascular cases were the most common manifestations. A tendency towards a changing clinical pattern of neurosyphilis was confirmed. Dementia and personality changes were the most frequently observed clinical symptoms. The classical signs of tabes dorsalis were seen in only very few patients. Stroke was a common manifestation. We recommend Standard Serological Tests for Syphilis to be carried out in patients under 60 years of age with cerebrovascular diseases, dementia and in patients where neurosyphilis could be even a remote diagnostic possibility.
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PMID:The incidence and clinical presentation of neurosyphilis in Greater Copenhagen 1974 through 1978. 721 Nov 89

Approximately 5,000 new cases of neurosyphilis may occur in the United States each year. General paresis and tabes dorsalis, however, have become relatively rare since the introduction of penicillin. Seizures, neuro-ophthalmologic symptoms, stroke and acute meningoencephalitis are currently the most common manifestations of neurosyphilis. In more than a third of patients with neurosyphilis, nontreponemal tests for syphilis (such as VDRL) are negative and should not be used to exclude the diagnosis. Specific treponemal tests are more sensitive and more specific. Examination of the cerebrospinal fluid may show no abnormalities in neurosyphilis and is not an infallible guide to the activity of the infection. Penicillin is the only proven antibiotic treatment of neurosyphilis. However, low-dose regimens do not produce spirocheticidal concentrations in the brain, and high-dose penicillin therapy is recommended to insure eradication of the spirochetes. Doxycycline, a tetracycline derivation that achieves relatively high concentration in the brain, may also be effective.
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PMID:Modern neurosyphilis: a partially treated chronic meningitis. 734 Jan 18

Meningovascular neurosyphilis (MN) is an unusual cause of stroke in young adults. The clinical manifestations include prodromal symptoms weeks or months before definitive stroke. The diagnosis is based on clinical findings and examination of the serum and cerebrospinal fluid. We report a case of MN with basilar artery irregularities demonstrated by magnetic resonance angiography.
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PMID:Magnetic resonance angiography in meningovascular syphilis. 804 41

Cerebrovascular ischemia can be caused by infectious diseases which involve cerebral arteries or the heart, including infectious endocarditis, bacterial and fungal meningitis, neurosyphilis, neuroborreliosis, herpes zoster, the acquired immunodeficiency syndrome, cat scratch disease and other rare infectious diseases. Presently, there is increasing evidence that infection in general and mainly respiratory infection is a risk factor for ischemic stroke. Case reports and smaller case series reported an association of cerebrovascular ischemia and recent infection in children and younger adults. Two case control studies from Helsinki (54 patients under the age of 50) and from Heidelberg (197 patients aged 80 or less) identified recent infection as an important risk factor for ischemic stroke. Febrile, bacterial and respiratory infections were most important in this respect. In the study from Heidelberg, the neurological deficit was more severe and cardioembolism was more frequent in infection-associated stroke than in stroke without preceding infection. This review summarizes the association of infectious diseases and cerebrovascular ischemia and discusses potential pathogenetic mechanisms linking both diseases.
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PMID:[Infectious diseases as a cause and risk factor for cerebrovascular ischemia]. 880 9


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