Late Neurosyphilis with Gradually Increasing Cerebellar Ataxia and Ischemic Strokes
The article describes a male patient with late neurosyphilis, which debuted at the age of 46, 9 years after infection, and manifested with gradually increasing cerebellar ataxia because of which the patient could not walk, moderate cognitive impairment and two mild ischemic strokes at the age of 48. Magnetic resonance imaging/magnetic resonance angiography of the brain revealed cortical sulci widening of the brain hemisphere and the cerebellum, small infarcts in both brain hemispheres, occlusion of both internal carotid artery (ICA) and ICA wall contract enhancement. Serological tests indicated syphilis in the past history. Tests for syphilis in the cerebrospinal fluid (CSF) were negative, the CSF protein level was 0.524 g/l, and cytosis was 2/3. Treatment with ceftriaxone led to substantial improvement, as the patient became able to walk independently. The obtained results suggests that gradually progressive ataxia and cognitive impairment were due to syphilitic arteritis of small vessels rather than neurodegeneration, which explained the significant clinical effect of antibiotic treatment. Syphilitic arteritis of both ICA was the cause of their occlusion and ischemic strokes. Diagnosis of late neurosyphilis is based on a comprehensive assessment of clinical and laboratory data. The sensitivity of specific tests in CSF may be low.