Isolated middle cerebral artery stenosis caused by syphilitic vasculitis
Ping Zhang
A # , Lei Chen A # , Shiyue Chen B , Tao Wu A * and Yongwei Zhang A *
A Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
B Department of Imaging, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
Handling Editor: Somesh Gupta
Sexual Health 20(1) 80-82 https://doi.org/10.1071/SH22147
Submitted: 8 September 2022 Accepted: 16 November 2022 Published: 2 December 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Syphilitic vasculitis (SV) is rare and difficult to be diagnosed. High-resolution vessel wall magnetic resonance imaging (HR-VWI) might be valuable in the diagnosis by differentiating SV from other vessel wall pathologies.
Methods: We report a rare case with severe isolated middle cerebral artery (MCA) stenosis and cerebral infarction, which was evaluated by serial HR-VWI.
Results: A 46-year-old woman presented with an acute infarct in the left basal ganglia and severe isolated stenosis in left middle cerebral artery (MCA). Cerebrospinal fluid (CSF) analysis was performed and the findings were consistent with neurosyphilis diagnosis. The MCA stenosis was also suspected to be the result of SV. HR-VWI revealed the evidence of concentric thickening and circular uniform enhancement of the arterial wall. After two cycles of anti-syphilis treatment, subsequent HR-VWI showed that the MCA stenosis was reduced significantly except slight enhancement of the arterial wall, which confirmed that the SV caused the isolated MCA stenosis.
Conclusions: HR-VWI could be an important diagnostic tool for isolated middle cerebral artery stenosis caused by SV, which could serve as a biomarker for assessing the response to anti-syphilis treatment in the future.
Keywords: cerebral infarction, cerebrospinal fluid, diagnosis, magnetic resonance imaging, middle cerebral artery, penicillin G, syphilis, vasculitis.
References
[1] Boog GHP, Lopes JVZ, Mahler JV, Solti M, Kawahara LT, Teng AK, et al. Diagnostic tools for neurosyphilis: a systematic review. BMC Infect Dis 2021; 21 568| Diagnostic tools for neurosyphilis: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[2] Tandon V, Senthilvelan S, Sreedharan SE, Kesavadas C, Vt J, Sylaja PN. High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease. Neuroradiology 2022; 64 1569–77.
| High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease.Crossref | GoogleScholarGoogle Scholar |
[3] Bagatti D, Mazibrada J, Ligarotti GKI, Nazzi V, Franzini A. A singular case of neurosyphilis manifesting through a meningovascular chronic inflammatory process in association with the occurrence of two aneurysms involving the distal A2 segment of both anterior cerebral arteries: a case report and review of the literature. World Neurosurg 2016; 87 662.e13–8.
| A singular case of neurosyphilis manifesting through a meningovascular chronic inflammatory process in association with the occurrence of two aneurysms involving the distal A2 segment of both anterior cerebral arteries: a case report and review of the literature.Crossref | GoogleScholarGoogle Scholar |
[4] Ahbeddou N, El Alaoui Taoussi K, Ibrahimi A, Ait Ben Haddou EH, Regragui W, Benomar A, et al. Stroke and syphilis: a retrospective study of 53 patients. Rev Neurol (Paris) 2018; 174 313–8.
| Stroke and syphilis: a retrospective study of 53 patients.Crossref | GoogleScholarGoogle Scholar |
[5] Mossa-Basha M, Shibata DK, Hallam DK, de Havenon A, Hippe DS, Becker KJ, et al. Added value of vessel wall magnetic resonance imaging for differentiation of nonocclusive intracranial vasculopathies. Stroke 2017; 48 3026–33.
| Added value of vessel wall magnetic resonance imaging for differentiation of nonocclusive intracranial vasculopathies.Crossref | GoogleScholarGoogle Scholar |
[6] Schaafsma JD, Hui F, Wisco D, Staugaitis SM, Uchino K, Kouzmitcheva E, et al. High-resolution vessel wall MRI: appearance of intravascular lymphoma mimics central nervous system vasculitis. Clin Neuroradiol 2017; 27 105–8.
| High-resolution vessel wall MRI: appearance of intravascular lymphoma mimics central nervous system vasculitis.Crossref | GoogleScholarGoogle Scholar |
