and 1 other(s)
A 45 years old male was admitted to our hospital with a left pontine stroke causing dysarthria and dyshagia, because after his transfer to a neurorehabilitation facility the neurologic deficits worsened and he developed fever. Initially he was treated in another hospital with this stroke, was diagnosed with an PFO and APC-resistance and started on phenprocoumon for suspected embolic stroke. MRI showed an ischemic stroke in the left pons and new ischemic lesions in the right internal capsule, the MR-angiography demonstrated stenosis of the basilar artery and of the right ACM. Subtraction angiography confirmed these stenotic changes, which were deemed arteriosclerotic at this point. Echocardiography and lab excluded endocarditis, antiphosholipid-syndrome or vasculitis. Within a few days the patient the patient developed an anarthria, he became stuporose. The follow-up MRI showed a new ischemic lesion involving the right pons. After correction of coagulation disorder (due to VKA) we performed a lumbar puncture. The CSF showed a pleocytosis with 93 cells/µl with elevated CSF-protein (1100 mg/l), without intrathecal immunglobuline synthesis but with oligoclonal bands and elevated TPPA-titre (CSF 1:64, serum 1:10240). VDRL-titre was 1:128, FTA-Abs 1:1600, leading to the diagnosis of meningovascular syphilis and initiation of an antibiotic treatment with penicilline, which resulted in normalization of serologic markers. Conclusions: Meningovascular syphilis is an easily missed, but treatable cause of recurrent stroke.
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