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Título

ATYPICAL PRESENTATION OF NEUROSYPHILIS AS STROKE-LIKE SYNDROME - A CASE REPORT

RESUMO

CASE PRESENTATION: J.C.O, male, 53y, admitted with sudden left hemiparesis, being referenced to the Neurology referral hospital for thrombolysis window protocol. Upon admission, he had an 11 NIHSS score with temporo-spatial disorientation, mild facial palsy and dysarthria, paresis with hypoesthesia on left hemibody and bilateral amaurosis. He reported optic neuritis diagnosis when he presented bilateral amaurosis in 2013 and carried out an incomplete investigation at the time, by his own choice. In view of the situation, the case was then conducted as a Cerebrovascular Accident (CVA), but the patient was not thrombolysed due to a contraindication related to the time of admission. Etiological investigation exams were performed, showing normal results. Serology with VDRL and rapid test came back positive. The patient was then submitted to cerebrospinal fluid puncture, which showed increased cellularity of 24 and reactive VDRL. During hospitalization, the family reported that the patient had been experiencing markedly cognitive impairment with memory loss, behavior and psychological changes. He was treated with Crystalline Penicillin according to the protocol and on the 14th day of treatment showed motor, sensory and cognitive improvement, being able to walk and carry out his activities without assistance, maintaining the previous amaurosis. DISCUSSION: Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It is estimated the incidence of 12 million cases per year, more than 90% being in developing countries. Neurosyphilis occurs in less than 10% of cases, and its most commonly observed form presents with neuropsychiatric changes. Only 3% of cases are associated with CVA, due to an infiltrative inflammatory process, most commonly of the middle cerebral artery. It is thought that the patient's previous optic neuritis may have been an even more uncommon manifestation of neurosyphilis. FINAL COMMENTS: This case illustrates an atypical manifestations of neurosyphilis. It is important to remember that this condition can be a primary etiology for stroke, especially in patients under 50 years of age, as well as for optic neuritis. Therefore, a detailed evaluation is essential in patients with initial investigation for normal stroke or atypical natural history. Once the diagnosis is made, treatment can prevent an unfavorable evolution and provide a significant clinical improvement.

Palavras Chave

Neurosyphilis; stroke; atypical