The great imitator behind an ischemic stroke: a case of meningovascular syphilis.
Emilio Altavilla, Luca Bortolani, Anna Carraro et al.
✦ AI-curated · Sources linked
Case in brief
A 41-year-old male presented with left facial weakness initially diagnosed as Bell's palsy. Four days later, he developed left-sided hemiparesis and dysarthria, leading to neuroimaging that confirmed a right nucleocapsular ischemic stroke. Cerebrospinal fluid analysis indicated pleocytosis and a reactive VDRL, diagnosing meningovascular neurosyphilis. After 14 days of intravenous Penicillin G, he achieved complete clinical recovery within six months.
What made this case unusual
The case illustrates how isolated cranial nerve deficits can precede a more serious condition like meningovascular syphilis, which can mimic other neurological disorders.
Diagnostic / clinical pearl
In young patients with ischemic stroke and no vascular risk factors, consider neurosyphilis, especially if there are preceding cranial nerve deficits.
Why it matters
This case underscores the importance of recognizing neurosyphilis as a reversible cause of ischemic stroke amid a resurgence of syphilis infections.