Locked-in Syndrome Due to Meningovascular Syphilis: A Case Report and Literature Review

We herein report a 46-year-old man presenting with locked-in syndrome secondary to meningovascular syphilis. Brain magnetic resonance imaging (MRI) demonstrated multiple acute infarctions in the left ventromedial pons, right basis pontis, and left basal ganglia. His locked-in syndrome was hypothesized to have been caused by thrombosis of the small paramedian branches of the basilar artery due to syphilitic arteritis. This is a unique case of bilateral ventromedial pontine infarction caused by meningovascular syphilis that presented as locked-in syndrome. Meningovascular syphilis should be included in the differential diagnosis of uncommon stroke, particularly in young men.

[1]  S. Ram,et al.  The Modern Epidemic of Syphilis. , 2020, The New England journal of medicine.

[2]  L. Zhong,et al.  Young male with syphilitic cerebral arteritis presents with signs of acute progressive stroke , 2019, Medicine.

[3]  A. Zini,et al.  Posterior circulation ischaemic stroke—a review part I: anatomy, aetiology and clinical presentations , 2019, Neurological Sciences.

[4]  L. Mouthon,et al.  Treatment of Syphilis-Associated Cerebral Vasculitis: Reappearance of an Old Question. , 2018, The American journal of medicine.

[5]  Juan Li,et al.  Bilateral wallerian degeneration of the middle cerebellar peduncles secondary to pontine infarction: A case series , 2018, Journal of the Neurological Sciences.

[6]  Tzung-Chang Tsai,et al.  Repeated episodes of acute stroke as manifestation of neurosyphilis in a well-controlled human immunodeficiency virus-infected patient-Successful treatment with ceftriaxone. , 2017, Journal of the Formosan Medical Association = Taiwan yi zhi.

[7]  M. Unemo,et al.  2014 European guideline on the management of syphilis: giving evidence priority , 2016, Journal of the European Academy of Dermatology and Venereology : JEADV.

[8]  A. Sullivan,et al.  UK national guidelines on the management of syphilis 2015 , 2016, International journal of STD & AIDS.

[9]  F. J. Carod Artal Clinical management of infectious cerebral vasculitides , 2016, Expert review of neurotherapeutics.

[10]  Fred Plum,et al.  [The diagnosis of stupor and coma]. , 2015, Brain and nerve = Shinkei kenkyu no shinpo.

[11]  C. Weiller,et al.  The great imitator--still today! A case of meningovascular syphilis affecting the posterior circulation. , 2015, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[12]  D. Goldsher,et al.  Clinical and imaging findings in patients with neurosyphilis: a study of a cohort and review of the literature , 2014, International journal of dermatology.

[13]  Guan Li-feng,et al.  Meningovascular syphilis with basilar artery occlusion: case report and literature review. , 2014, Neurology India.

[14]  Y. Sung,et al.  Neuro-syphilis, HIV infection and brainstem infarction. , 2013, QJM : monthly journal of the Association of Physicians.

[15]  L S Illis,et al.  Handbook of clinical neurology , 2013, Spinal Cord.

[16]  W. Feng,et al.  Meningovascular syphilis with fatal vertebrobasilar occlusion. , 2009, The American journal of the medical sciences.

[17]  Taim A. Muayqil,et al.  The re-emergence in Canada of meningovascular syphilis: 2 patients with headache and stroke , 2007, Canadian Medical Association Journal.

[18]  C. Wright,et al.  Meningovascular syphilis as a cause of basilar artery stenosis , 2005, Neurology.

[19]  S. Kudo,et al.  Symmetrical lesions of the middle cerebellar peduncle: MR imaging and differential diagnosis. , 2004, Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine.

[20]  R. Crupi,et al.  Meningovascular syphilis and improvement with tissue-plasminogen activator (T-PA). , 2004, The American journal of emergency medicine.

[21]  S. Harik,et al.  Acute bilateral inferior cerebellar infarction in a patient with neurosyphilis. , 2004, Archives of neurology.

[22]  J. Zubieta,et al.  Magnetic resonance angiography in meningovascular syphilis , 1994, Neuroradiology.

[23]  F. Gerstenbrand,et al.  Varieties of the locked-in syndrome , 1979, Journal of Neurology.

[24]  H. Prange,et al.  Relationship between neurological features and intrathecal synthesis of IgG antibodies to Treponema pallidum in untreated and treated human neurosyphilis , 2004, Journal of Neurology.

[25]  K. Holmes,et al.  Update on syphilis: resurgence of an old problem. , 2003, JAMA.

[26]  G. Burstein,et al.  Sexually transmitted diseases treatment guidelines , 2003, Current opinion in pediatrics.

[27]  J. Berger,et al.  Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings. , 1995, AJNR. American journal of neuroradiology.

[28]  R. Mathias,et al.  An Evaluation of Oligoclonal Banding and CSF IgG Index in the Diagnosis of Neurosyphilis , 1990, Sexually Transmitted Diseases.

[29]  S. W. Parker,et al.  Pure motor hemiplegia due to meningovascular neurosyphilis. , 1987, Archives of neurology.

[30]  V Sahgal,et al.  Mortality and complications of the locked-in syndrome. , 1987, Archives of physical medicine and rehabilitation.

[31]  M. Grabois,et al.  Locked-in syndrome: a review of 139 cases. , 1986, Stroke.

[32]  M. Holmes,et al.  Clinical features of meningovascular syphilis , 1984, Neurology.

[33]  E. Norrby,et al.  Neurosyphilis: Intrathecal synthesis of oligoclonal antibodies to treponema pallidum , 1982, Annals of neurology.

[34]  R. Griggs,et al.  Recovery from the locked-in syndrome. , 1982, Transactions of the American Neurological Association.

[35]  G. Tibbling,et al.  Principles of albumin and IgG analyses in neurological disorders. III. Evaluation of IgG synthesis within the central nervous system in multiple sclerosis. , 1977, Scandinavian journal of clinical and laboratory investigation.

[36]  J. Musser,et al.  The American Journal of Medical Sciences , 1847, Illinois and Indiana Medical and Surgical Journal.