Chapter 2.1 - Meningovascular Syphilis

Summary

Syphilis is one of the infectious common cause of stroke. It accounted for about 2-5% of all cause of ischaemic stroke especially in the young people lived in human immunodeficiency virus pandemic era. The pathologic pattern is meningo-vasculitis and endarteritis. The lesions relate to the cortical and leptomeningeal superficial vessels and can extend to the arteries of medium and large caliber, but rarely in the small arteries Typically the common clinical presentation is the subacute vascular syndrome with the past history of chancre. The diagnosis is based on the combination of past history of chancre in a young people (particularly in HIV infected patient), systemic inflammatory signs, infarction (rarely hemorrhage) in brain imaging and cerebro-spinal fluid positivity of Venereal Disease Research Laboratory and lymphocytic pleiocytosis. The CSF Fluorescent Treponemal Antibody absorption (FTA-ABS or Nelson test) has a high sensitivity. The treatment includes the use of antibiotics (benzyl-penicillin or ceftriaxon for 10-14 days), the management of vascular risk factors and strategy to avoid other behavior toward sexual transmitted disease