Aspect IRM de la neuropsyphillis

Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry

Introduction

In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned.

Patients and methods

We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF.

Results

Syphilitic etiology was retained for six (6) patients (4 men and 2 women) with a mean age of 43 years (extremes 36 and 49 years). The clinical picture was dominated by carotid syndromes: superficial and deep sylvian syndrome, anterior cerebral artery syndrome and vertebro-basilar syndromes and one case of lacunar syndrome.The diagnosis was based on the positivity of serological reactions (VDRL-TPHA) in blood and cerebrospinal fluid (CSF) and the presence of a predominantly lymphocytic hypercellularity and a hyperproteinorachy in the CSF in the absence of any other etiology.

Conclusion

These neurological vascular syndromes consecutive to a cerebral treponematous attack are often the result of a still poorly conducted management of primary and secondary syphilis in our country.

Motor lumbosacral radiculopathy in HIV-infected patients

Background

This study is a review of the clinical findings and treatment outcome of 11 HIV-infected patients with motor lumbosacral radiculopathy.

Objectives

To describe the clinical, laboratory, electrophysiological features and treatment outcome in HIV-infected motor lumbosacral radiculopathy which is a rare manifestation of HIV.

Method

A retrospective review of HIV-infected patients with motor lumbosacral radiculopathy was performed at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa between 2010 and 2015.

Results

Eleven black African patients met the inclusion criteria. There were six women. The median age was 29 years, the interquartile range (IQR) was 23-41 years, the median duration of symptom progression was 6.5 months (IQR 3-7.5 months). The median CD4 count was 327 cells/µL (IQR 146-457). The cerebrospinal fluid (CSF) median polymorphocyte count was 0 cells/µL (IQR 0 cells/µL - 2 cells/µL), lymphocyte count was 16 cells/µL (IQR 1 cells/µL - 18 cells/µL), glucose level was 3.1 mmol/L (IQR 2.8 mmol/L - 3.4 mmol/L) and protein level was 1.02 g/dL (IQR 0.98 g/dL - 3.4 g/dL). All patients were treated with corticosteroid therapy. Ninety-one per cent recovered fully within 6 months of treatment, the median time for recovery was 3.4 months (IQR 1.8-5.6 months). There were no relapses during the 18-month follow-up.

Conclusion

HIV-infected patients with motor lumbosacral radiculopathy responded to corticosteroids, with no relapses during the 18-month follow-up period.

Changes in neurosyphilis presentation: a survey on 286 patients

Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.

Current clinical and epidemiological features of neurosyphilis

The authors present the results of the analysis of the dynamics of the neurosyphilis incidence rate based on the state statistical reporting data in the Volga Federal District in 2003—2011. According to the authors, there is a growth in new neurosyphilis cases against the background of the reduced incidence rate of syphilis. The authors also revealed that late forms of neurosyphilis dominate in the neurosyphilis incidence structure. They conducted an analysis of anamnestic and clinical data of patients who were diagnosed with neurosyphilis, and discovered and a number of particular features in the current clinical picture of the disease. According to the authors, basal meningitis mainly affecting the optic, oculomotor and eighth cranial nerve is diagnosed most often in case of early-onset neurosyphilis. Latent and often mono-symptom forms with prevalent intellectual, memory and emotional-volitional disorders are characteristic of late neurosyphilis.