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Título

BILATERAL THROMBOSIS OF THE MIDDLE CEREBRAL ARTERY BY NEUROSYPHILIS: AVCI

RESUMO

Case Apresentation
Male DC 61 years, complaint of right hemiparesis, dysarthria and sudden onset confusion 2 days ago. With progressive improvement, without alteration in the neurological exam already in 1 care. Initially, a protocol was performed for ischemic stroke (ICAVs) with skull resonance: ischemia sequelae in the left temporal and parietal lobe and left postcentral gyrus transthoracic echocardiogram and Doppler ultrasound of carotid and vertebral arteries without significant alterations. In laboratory investigation: fta abs reagent and vdrl 1/64. The study was carried out on cerebrospinal fluid: Leukocytes 70, neutrophils 2, lymphocytes 98, glucose 54 and proteins 75.2.
In the face of an etiological finding (neurosyphilis causing vascular injury), a patient submitted to intracranial arterial angio resonance (MMR), showing: Distal subocclusive stenosis of M1 in right MCA, parietal irregularities in M1 segment of left MCA and M2 bilaterally, and parietal irregularities with moderate stenosis in P2 to the right. RMIA confirms the etiological hypothesis, due to its classic pattern of arteritis by syphilis (Heubner's arteritis). DC was treated with crystalline penicillin for 14 days and kept asymptomatic on discharge. The patient unknown the diagnosis of syphilis, and it was impossible to determine the incubation period and showed comorbidities, only smoking.
DISCUSSION:
Syphilis, sexually transmitted, if untreated can reach its tertiary form reaching the central nervous system. DC presents the classic type of meningeal neurosyphilis. It has mainly manifested the AVCI secondary to vasculitis caused by treponema pallidum. The agent causes tapering of the vessel affected by fibroelastic proliferation of the intima, narrowing of the media and fibrosis associated with adventitia alterations, with preference for medium and large caliber arteries. There is appearance and collateral circulation, which explains clinical practice not compatible with image findings. As shown in the report, a poor clinic for an exuberant image.

FINAL COMMENTS:
Approximately 30% of patients without adequate treatment for neurosyphilis will present CNS involvement, them 70% are asymptomatic. Associated with a non-exuberant clinic and the growing number of syphilis cases, with 72.8 cases/100,000 inhabitants in Brazil, it is always necessary to continue the investigation of these infections in cns, using the vdrl test as proposed by the Ministry of Health as a screening

Palavras Chave

Neurosyphilis, bilateral thrombosis