scholarly journals 270. New Onset Seizure Presented as Neurosyphilis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S241-S242
Author(s):  
Shwe S Phyo ◽  
Cho T Zin ◽  
Zeyar Thet
Keyword(s):  
Brain Mri ◽  
Venereal Disease ◽  
False Negative ◽  
Treponema Pallidum ◽  
Clonic Seizure ◽  
Penicillin G ◽  
Serological Tests ◽  
History Of ◽  
The Brain ◽  
New Onset

Abstract Background The term “neurosyphilis” refers to infection of the central nervous system (CNS) by Treponema pallidum. It can occur at any time after initial infection. Early in the course of syphilis, the most common forms of neurosyphilis involve the cerebrospinal fluid (CSF), meninges, and vasculature (asymptomatic meningitis, symptomatic meningitis, and meningovascular disease). Late in disease, the most common forms involve the brain and spinal cord parenchyma (general paralysis of the insane and tabes dorsalis). Methods A 31-year-old man who suddenly developed a new onset generalized tonic clonic seizure, was admitted to the emergency department. He had no history of epilepsy and denied any vision or gait problems. The brain MRI showed no abnormalities. He had a history of rapid plasma reagent (RPR) titer 1:32 and a positive fluorescent treponemal antibody absorption (FTA-ABS) test in 2017. However, the RPR result was non-reactive when he retested a week later and therefore was not diagnosed with syphilis and did not get treated at that time. His most recent RPR titer was 1:16. HIV serology and other STD tests were all negative. His wife and his 3 kids were negative for syphilis. Due to serological evidence of syphilis and neurological symptoms, we arranged him to get a lumbar puncture to rule out neurosyphilis. Results His CSF study showed positive venereal disease research laboratory (VDRL), WBC cell count 44 cells/ul (lymphocytes 80%, Neutrophil 20%), Glucose 50 mg/dl, Protein 75 mg/dl. Based on the CSF study, he was diagnosed with neurosyphilis and was treated with intravenous Penicillin G 3-4 million units every 4 hours for 14 days, followed by Benzathine Penicillin 2.4million units intramuscularly on day 21. Conclusion This is an unusual case because his false negative RPR result has hindered the prompt diagnosis and management of syphilis. RPR is a nontreponemal test and therefore it is not always reliable as a diagnostic criteria. False negatives in RPR may occur in certain conditions such as in early primary or in late stage syphilis and prozone phenomenon. This case illustrates the importance of using a reverse sequence algorithm in diagnosing syphilis. Thorough history taking is also crucial in conjunction with serological tests to determine the diagnosis and to ensure appropriate treatment. Disclosures All Authors: No reported disclosures

scholarly journals Meningovascular neurosyphilis as the cause of ischemic cerebrovascular disease in a young man

2011 ◽  
Vol 152 (19) ◽  
pp. 763-767 ◽  
Author(s):  
Veronika Tóth ◽  
Csilla Hornyák ◽  
Tibor Kovács ◽  
Béla Tóth ◽  
György Várallyay ◽  
...  
Keyword(s):  
Short Term Memory ◽  
Brain Mri ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Memory Loss ◽  
Penicillin G ◽  
Caudate Nuclei ◽  
Ischemic Cerebrovascular Disease ◽  
Elevated Protein ◽  
Intrathecal Igg Synthesis

Authors report a case of a 35-year-old male with right-sided mild paresis, incontinence, dysexecutive syndrome, short-term memory loss and behavioral changes. Bilateral cerebral infarcts in the region of the caudate nuclei and the adjacent white matter were proved by brain MRI and multiple stenoses of the branches of Willis-circle were confirmed by MR angiography. Elevated protein level and pleocytosis were found in the cerebrospinal fluid with intrathecal IgG synthesis. Serum rapid plasma reagin, Treponema pallidum Particle Agglutination test, Treponema pallidum ELISA, liquor Venereal Disease Research Laboratory tests were positive. Meningovascular neurosyphilis was diagnosed. 24M U/day intravenous penicillin-G treatment was given for 14 days. The patient has vascular dementia due to the bilateral strategic infarcts disconnecting the prefrontal circuits; his symptoms are similar to general paresis. Laboratory and radiologic improvement was observed. Still, the patient have severe residual cognitive decline. Orv. Hetil., 2011, 152, 763–767.

scholarly journals Importance of Serological Tests in the Diagnosis of Asymptomatic Congenital Syphilis in Neonates: A Case Report

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Brigitta Ida Resita Vebrianti Corebima ◽  
Ayunda Almiradani ◽  
Eko Sulistijono
Keyword(s):  
Congenital Syphilis ◽  
Nasal Congestion ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Vital Role ◽  
Penicillin G ◽  
Serological Tests ◽  
Procaine Penicillin ◽  
Test Result

Introduction: Congenital Syphilis (CS) is caused by the vertical transmission of Treponema pallidum during pregnancy. Here, we describe a case of CS, diagnosed solely by serological tests. Case Presentation: The patient was a newborn with CS, whose mother was infected with Treponema pallidum at the gestational age of 16 - 20 weeks. However, the patient had no signs of early CS, such as low birth weight, nasal congestion, maculopapular rash, or hepatosplenomegaly. The histopathological features in both mother and neonate suggested syphilitic placentitis. Regarding the serological tests, a non-reactive Venereal Disease Research Laboratory (VDRL) test result and a reactive Treponema pallidum haemagglutination (TPHA) test result were reported. After establishing the diagnosis of CS, we initiated treatment with procaine penicillin G (50,000 U/kg body weight), which was injected intramuscularly once a day for 10 days. Six months after discharge, physical examinations showed normal findings and non-reactive results of VDRL and TPHA tests. Conclusions: It can be concluded that detailed history-taking and serological tests play a vital role in establishing the diagnosis of CS, particularly in patients with asymptomatic congenital syphilis. An early diagnosis of CS can guide clinicians to initiate a standardized treatment and improve patient outcomes.

Beware of cryptococcomas when treating Cryptococcal meningitis

2020 ◽  
Vol 10 (5) ◽  
pp. 183-184
Author(s):  
Rafael Ferreira Nascimento ◽  
Diogo Raposo André, ◽  
Fabiana Gouveia ◽  
Nancy Faria ◽  
Ana Paula Reis
Keyword(s):  
Immunocompromised Patient ◽  
Brain Mri ◽  
Hiv Positive ◽  
Rare Presentation ◽  
Neck Stiffness ◽  
Viral Loads ◽  
Hiv Rna ◽  
Neurological Exam ◽  
History Of ◽  
The Brain

Introduction: The authors describe a rare presentation of central nervous system cryptococcosis in an immunocompromised patient. Case description: An HIV-positive patient, with poor adherence to the treatment, presented with a seventeen days history of severe headache. On the neurological exam there was only evidence of neck stiffness, he had a CD4 count of 23 cells/μl and plasma HIV RNA viral loads of 364,000 copies/ml. Lumbar puncture revealed positive for cryptococcal antigen virus and so treatment with amphotericin B was started. During his admission the patient developed an expressive aphasia with visual hallucinations and the brain MRI revealed cerebral cryptococcomas. After 98 days of treatment general and neurological examination was normal and the patient was discharged home. Conclusion: This case highlights a rare and severe complication of Cryptococcus neoformans infection in immunocompromised patients.

scholarly journals Causal Link between Ventricular Ectopy and Concussion

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
J. Patrick Neary ◽  
Jyotpal Singh ◽  
Jonathan P. Christiansen ◽  
Taylor A. Teckchandani ◽  
Kirsty L. Potter
Keyword(s):  
Brain Mri ◽  
Causal Link ◽  
Pharmacological Intervention ◽  
Ventricular Ectopy ◽  
Remarkable Change ◽  
Significant Incidence ◽  
Male Individual ◽  
Case Study Report ◽  
History Of ◽  
The Brain

We present a unique case study report of a male individual with a history of mild nonischaemic cardiomyopathy, with no ventricular ectopy, that at the age of 76 years sustained multiple concussions (i.e., mild traumatic brain injury) within a week of each other. Concussion symptoms included cognitive difficulties, “not feeling well,” lethargy, fatigue, and signs of depression. He was later medically diagnosed with postconcussion syndrome. The patient, WJT, was referred for cardiac and neurological assessment. Structural neuroimaging of the brain (MRI) was unremarkable, but electrocardiography (ECG) assessments using a 24-hour Holter monitor revealed significant incidence of ventricular ectopy (9.4%; 9,350/99,836 beats) over a period of 5–6 months after injury and then a further increase in ventricular ectopy to 18% (15,968/88,189 beats) during the subsequent 3 months. The patient was then prescribed Amiodarone 200 mg, and his ventricular ectopy and concussion symptoms completely resolved simultaneously within days. To the authors’ knowledge, our study is the first to show a direct link between observable and documented cardiac dysregulation and concussion symptomology. Our study has important implications for both cardiac patients and the patients that sustain a concussion, and if medically managed with appropriate pharmacological intervention, it can reverse ventricular ectopy and concussion symptomology. More research is warranted to investigate the mechanisms for this dramatic and remarkable change in cardiac and cerebral functions and to further explore the brain-heart interaction and the intricate autonomic interaction that exists between the extrinsic and intracardiac nervous systems.

Atypical development of neurosyphilis mimicking limbic encephalitis

2018 ◽  
Vol 30 (2) ◽  
pp. 194-197 ◽  
Author(s):  
Karine Beiruti ◽  
Anan Abu Awad ◽  
Galina Keigler ◽  
Chen Hanna Ryder ◽  
Radi Shahien
Keyword(s):  
Limbic Encephalitis ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Penicillin G ◽  
Acute Confusional State ◽  
Gradual Improvement ◽  
Atypical Clinical Presentation ◽  
Magnetic Resonance Imaging Mri ◽  
Atypical Development ◽  
Simplex Virus

A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three months was referred to our facility. On admission, the patient was dysphasic and had tonic-clonic seizures. Neurological examination showed mental confusion, euphoric mood, mania, paranoia, and mild motor dysphasia. Magnetic resonance imaging (MRI) was performed twice but no abnormalities were revealed. His acute confusional state, elevated cerebrospinal fluid (CSF) protein, epileptic seizure and electroencephalogram showing intermittent frontal slowness were all suggestive of encephalitis. The patient was treated with acyclovir without significant improvement in his condition. Testing for herpes simplex virus and human immunodeficiency virus was negative. Limbic encephalitis was suspected and the patient was treated with intravenous immunoglobulin (IVIG) for five days. Venereal disease research laboratory and Treponema pallidum hemagglutination assay were both tested positive in serum and CSF. Neurosyphilis was diagnosed, and the patient received a 14-day course of penicillin G with gradual improvement. Anti-N-methyl-D-aspartate-receptor (anti-NMDAR) antibodies were positive in serum, confirming the presence of encephalitis. The atypical clinical presentation of neurosyphilis with symptomatology mimicking encephalitis and no MRI abnormalities made the diagnosis challenging. Coexistence of neurosyphilis with anti-NMDAR encephalitis has been reported only in one recent study. Our case demonstrates the importance of testing for syphilis in patients with unexplained neurologic deficits and suspected encephalitis.

scholarly journals Epidural Brain Metastases in a Patient with Early Onset Pancreatic Cancer: A Case Report and Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Aibek E. Mirrakhimov ◽  
Farah N. Khan
Keyword(s):  
Pancreatic Cancer ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Brain Metastases ◽  
Early Onset ◽  
Brain Mri ◽  
Malignant Ascites ◽  
Cranial Irradiation ◽  
History Of ◽  
New Onset

We present a case of early onset pancreatic cancer related extra-axial brain metastases. A 46-year-old Caucasian non-Jewish nonobese male with a history of PC diagnosed 3 months ago with metastases to the liver, omentum, malignant ascites, and a history of a pulmonary embolism was admitted to the hospital because of a new onset headache, nausea, and vomiting which started 2 days prior to the encounter. Brain MRI was ordered, which showed acute bihemispheric subdural hematomas and left hemispheric extra-axial heterogeneously enhancing lesions consisting with metastatic disease. The patient was started on ondansentron, metoclopramide, and dexamethasone. The cranial irradiation was started, and the patient’s headache and nausea significantly improved. There are only 9 published reports of extra-axial brain metastases related to the pancreatic cancer, whereas our paper is the first such case reported on a patient with epidural metastases and early onset pancreatic cancer.

scholarly journals Child Neurology (Neurocritical Care/Neuro Trauma)

2015 ◽  
Vol 42 (S1) ◽  
pp. S24-S24
Author(s):  
JA Mailo ◽  
J Pugh ◽  
FD Jacob
Keyword(s):  
Bacterial Meningitis ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Neurological Deficits ◽  
Search Terms ◽  
History Of ◽  
Streptococcal Meningitis ◽  
The Brain ◽  
New Onset

Background: Focal neurological deficits occur in approximately 15% of children with bacterial meningitis. However, cranial nerve involvement such as facial-nerve palsy is uncommon in non-tuberculous bacterial meningitis. Methods: Case Report. Review of the literature was conducted on Pubmed for the search terms: facial nerve palsy and meningitis. Results: We present the case of a 4-year old right-handed girl who presented with a new onset unilateral facial nerve palsy preceded by 5-day history of fever and headaches. The patient had meningeal signs and was identified to have Streptococcal Meningitis. MRI of the brain showed a large previously undiagnosed intranasal encephalocele. The facial palsy resolved within 7 days of antibiotic treatment. Conclusions: Our case represents an unusual combination of facial nerve palsy in context of Streptococcal Meningitis secondary to intranasal encephalocele.

scholarly journals Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

2021 ◽  
Vol 7 (6) ◽  
pp. 872
Author(s):  
Rajesh Munusamy ◽  
Nithin Nagaraja
Keyword(s):  
Sexual Abuse ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Intellectually Disabled ◽  
Transmitted Infection ◽  
Sexual Transmitted Infection ◽  
Benzathine Penicillin G

<p class="abstract">Syphilis is a sexual transmitted infection (STI) caused by a spirochete, <em>Treponema pallidum</em>. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and <em>Treponema pallidum </em>hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.</p><p class="abstract"> </p>

Treponema pallidum PCR testing for diagnosis of mucocutaneous ulcers suspicious for syphilis

2021 ◽  
pp. sextrans-2021-055192
Author(s):  
Muhammad Hyder Junejo ◽  
Mark Collery ◽  
Gary Whitlock ◽  
Alan McOwan ◽  
Victoria Tittle ◽  
...  
Keyword(s):  
Demographic Data ◽  
Treponema Pallidum ◽  
Added Value ◽  
Contact Tracing ◽  
Bisexual Men ◽  
Electronic Patient Records ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of

BackgroundPrimary syphilis is characterised by the appearance of an ulcerated lesion (chancre) on the anogenital or oral mucosa from which Treponema pallidum DNA may be detectable by PCR. Serological tests for syphilis may be non-reactive in early infection, even after the appearance of a chancre. We reviewed the use of a multiplex-PCR (M-PCR) test to determine the added value of T. pallidum DNA detection in the management of individuals presenting with mucocutaneous ulceration at a sexual health service in central London.MethodsWe performed a cross-sectional analysis of all individuals with detectable T. pallidum DNA from September 2019 to April 2020. Electronic patient records were reviewed and concomitant results for treponemal serology and/or rapid plasma reagin (RPR) extracted, along with demographic data, history of syphilis and indices of sexual behaviour including number of sexual partners contacted. Any subsequent treponemal serology and RPR results were also reviewed.ResultsM-PCR swab specimens were performed in 450 individuals, of whom 63 (14%) had detectable T. pallidum DNA; 60 of 63 (95%) were gay or bisexual men and 11 of 63 (17%) were living with HIV. A history of treated syphilis was present in 17 of 63 (27%). Same-day treponemal serology/RPR testing was performed in 58 of 63 (92%) patients. Of the 58 who had same-day syphilis serology/RPR, 9 (16%) had their syphilis infection confirmed by treponemal DNA PCR alone. A total of 165 partners were traced as contacts of infection, of whom 25 (15%) were contacts of individuals diagnosed by M-PCR testing alone.ConclusionIn individuals with T. pallidum PCR-positive lesions, around one in six in our cohort were negative on standard diagnostic serological tests for syphilis. Treponemal DNA testing is an important addition to serological assays in individuals with mucocutaneous ulceration who are at risk of recent syphilis infection and facilitates early diagnosis and contact tracing.

Activation-Resistant Homozygous Protein C R229W Mutation Causing Familial Perinatal Intracranial Hemorrhage

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3587-3587
Author(s):  
Abdulrahman Alsultan ◽  
Andrew J. Gale ◽  
Kadijah Kurban ◽  
Mohammed Khalifah ◽  
Fahad B. Albadr ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Protein C ◽  
Conflicts Of Interest ◽  
Brain Mri ◽  
Purpura Fulminans ◽  
Amidolytic Activity ◽  
Protein Z ◽  
History Of ◽  
Hands And Feet ◽  
The Brain

Abstract Two first-degree cousins presented with similar phenotype characterized by neonatal intracranial hemorrhage and subsequent onset of thrombosis at the age of four months. One girl, now 9 yr old, was a full term baby presenting at 13 days of age with seizures and brain CT showing intracranial hemorrhage. At 4 months of age, she presented with multiple thrombotic lesions over both hands and feet that required extensive debridement and improved with anticoagulation and plasma replacement. She has been on enoxaparin with no new lesions afterward. At 9 years of age, protein C amidolytic activity (STACHROM® protein C) was 61% (nl 70-140%) and protein C antigen (ELISA) was 57% (nl 70-140%). Thrombophilia work up was otherwise normal. The second child is a 1 yr old boy who was delivered by cesarean section because of fetal distress. The mother gave history of decreased fetal movement for few weeks prior to his birth and was noted to be hypotonic. Brain MRI in the first week of life showed massive subacute hemorrhage in the brain parenchyma and upper spinal canal. Bleeding stopped with appropriate supportive care. He did not have purpura fulminans or any evidence of thrombosis during the neonatal period. At 4 months of age, a ventriculoperitoneal shunt was placed because of hydrocephalus and post operatively he developed thrombotic lesion in his left foot that resolved after starting enoxaparin and plasma replacement. He remains on enoxaparin with no new significant lesions. At 10 months of age, protein C amidolytic activity was 59% and protein C antigen was 73%. Both patients suffer from severe permanent neurological deficit and blindness. Dx of protein C homozygous deficiency was established after exome sequencing of the older child revealed a homozygous variant in exon 9 of PROC gene c.811 C>T (R271W equivalent to R229W in mature protein C numbering). Sanger sequencing validated this mutation. Both patients were homozygous (T/T) while tested parents and two siblings were heterozygous (C/T), and 55 controls were normal (C/C). No family history of thrombosis among family members who are heterozygous for this mutation was found. Complete exome sequence analysis also showed no mutations for ATIII, protein S, factors V or VIII, prothrombin, plasminogen, protein Z, or any ADAMTS genes. The R229W mutation is located in the calcium binding loop of protein C's protease domain that mediates thrombomodulin (TM) interactions. To define functional abnormalities caused by the patients' mutation, recombinant protein C mutants R229W, R229Q and R229A were studied. Each was strikingly defective in rate of activation by thrombin:TM, showing an activation rate that was only 1%, 2% and 4%, respectively, compared to wildtype protein C. Once activated, each activated protein C (APC) mutant was moderately affected, showing a 50% reduction in anticoagulant activity and in rate of cleavage of purified factor Va at Arg506. The amidolytic activities were less affected and close to wildtype APC. The plasma half-lives were similar to wildtype APC. These properties of recombinant R229W protein C strongly suggest a severe in vivo deficit in these children for generation of APC, implying a severe deficiency of APC in spite of half-normal levels of protein C zymogen. As routine coag assays utilize snake venom protease, they fail to detect TM-activation-resistant protein C mutants. In summary, homozygous protein C R229W mutation in two related cousins was associated with significant leaky brain blood vessels in the perinatal period and significant neurological insult even prior to the first evidence of clinical thrombosis. This highlights the importance of protein C and APC in maintaining the integrity of the brain vascular endothelium in humans. Disclosures: No relevant conflicts of interest to declare.

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