MENINGOVASCULAR NEUROSYPHILIS: A CASE REPORT
INTRODUCTION Syphilis is a bacterial infection usually contracted by sexual contact with lesions or infected body fluids and the invasion of the meninges occurs by Treponema pallidum¹ during systemic dissemination. The classification for syphilis in this case report is asymptomatic neurosyphilis, that is, there are only changes in cerebrospinal fluid (CSF), namely lymphocytic pleocytosis, elevation of proteins and serological reactions of syphilis positive², without any symptoms or clinical signs. In the absence of treatment, asymptomatic neurosyphilis may persist in this way, resolve spontaneously or progress to symptomatic forms. The longer the time elapsed after the initial infection, with persistent changes in the cerebrospinal fluid, the greater the likelihood of the development of symptomatic neurological disease.
CASE REPORT A 28 year old male patient attended the outpatient clinic with neurology on July 11, 2016, with a history of incomplete hemihypoesthesia on the left of rapid installation (numbness in the face and left leg) in the period of 1 hour, on July 4, 2016. The patient denied any other neurological deficit, but complained of bitemporal headache characterized by mild to moderate intensity, with periods of exacerbation, which began in February of the same year. There was denial of any history of headache prior to this period, in addition, he reported that in the last few days he had attended with discomfort, fatigue during his usual activities and nausea.
DISCUSSION AND CONCLUSION Regarding the neurological exams, the mental state, language and speech were preserved, without alterations in the cranial pairs, of the strength and the sensibility. Tendon reflexes of classification 2+ globally and plantar cutaneous reflex in bilateral flexion were observed. The patient did not present alterations in the appendicular and axial coordination, in the static or dynamic balance. It was found atypical gait, but did not present meningeal signs and also did not present sphincteric impairment. In the resonance, a hyperintensity was observed in the right parietal region, justifying the
left hemihypoesthesia. When a contrast was injected in this area, gyral enhancement was shown in the image, at first there was suspicion of an acute ischemic event, however, taking into account the patient's age of 28 years, this hypothesis was discarded. Thus, the patient was admitted to the UFGD University Hospital for treatment and further examination. Regarding the clinical exams, the patient did not present alterations of the cardiovascular and respiratory apparatus, the abdomen was normotensive, flat, without visceromegaly or pain when palpated and the presence of lymph nodes or cutaneous alterations were not observed. Regarding the laboratory tests, the screening test for Syphilis showed that the patient was reagent for both the rapid (immunochromatographic) test and the VDRL (flocculation) reaction, for the anti-HIV test, the result was also reagent. In addition, the cerebrospinal fluid presented clear and colorless features; however, the erythrocytes showed values of 3 p/mm³ and leukocytes of 83 p/mm³. Regarding the biochemical tests, after the centrifugation of the cerebrospinal fluid, the results showed values for proteins of 103.11 mg/dL, with normal values of 20 to 40 mg/dL. Thus, with syphilis, gyral hyperintensity4, changes in cellularity with leukocyte levels at 83 p/mm³, with normal values below 50 p/mm³ and exacerbated changes in protein levels, the treatment for Neurosyphilis is mandatory. Such treatment was done with intravenous Crystalline Penicillin to control the symptoms, microorganisms and the improvement of the patient's condition.
Microbiologia Médica.MURRAY. P.R. et al. 5th ed. Rio de Janeiro: Elsevier, 2006. 2. Pathological bases of diseases. KUMAR, V.; ABBAS, A.K.; FAUSTO, N .; MITCHELL, R. N. Robbins. 7. ed. Rio de Janeiro: Elsevier, 2005. 3. Neurosyphilis - Clinical and Laboratory Review. Ana Margarida Barros *; Ana Paula Cunha; Carmen Lisboa *; Maria José Sá †; Carlos Resende. 4. Neurosyphilis: a brief review. Leonardo Caixeta, Vânia Lúcia Dias Soares, Giane Divina Reis, Jean Newton Lima Costa and Ana Caroline Marques Vilela.
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