A Singular Case of Neurosyphilis Manifesting Through a Meningovascular Chronic Inflammatory Process in Association with the Occurrence of Two Aneurysms Involving the Distal A2 Segment of Both Anterior Cerebral Arteries: A Case Report and Review of the Literature

Isolated middle cerebral artery stenosis caused by syphilitic vasculitis

BACKGROUND

Syphilitic vasculitis (SV) is rare and difficult to be diagnosed. High-resolution vessel wall magnetic resonance imaging (HR-VWI) might be valuable in the diagnosis by differentiating SV from other vessel wall pathologies.

METHODS

We report a rare case with severe isolated middle cerebral artery (MCA) stenosis and cerebral infarction, which was evaluated by serial HR-VWI.

RESULTS

A 46-year-old woman presented with an acute infarct in the left basal ganglia and severe isolated stenosis in left middle cerebral artery (MCA). Cerebrospinal fluid (CSF) analysis was performed and the findings were consistent with neurosyphilis diagnosis. The MCA stenosis was also suspected to be the result of SV. HR-VWI revealed the evidence of concentric thickening and circular uniform enhancement of the arterial wall. After two cycles of anti-syphilis treatment, subsequent HR-VWI showed that the MCA stenosis was reduced significantly except slight enhancement of the arterial wall, which confirmed that the SV caused the isolated MCA stenosis.

CONCLUSIONS

HR-VWI could be an important diagnostic tool for isolated middle cerebral artery stenosis caused by SV, which could serve as a biomarker for assessing the response to anti-syphilis treatment in the future.

The Use of Intracranial Vessel Wall Magnetic Resonance Imaging to Detect a Presumptive Syphilitic Brain Aneurysm

ABSTRACT

Syphilitic intracranial aneurysm is a rare presentation of meningovascular syphilis in developed countries. In this case report, we discuss the utilization of the intracranial vessel wall magnetic resonance imaging in the management of a patient with a rare fusiform brain aneurysm, positive syphilis serologies, and inconclusive cerebrospinal fluid findings.

King Charles VIII of France's Death: From an Unsubstantiated Traumatic Brain Injury to More Realistic Hypotheses

On April 7, 1498, Charles VIII, King of France, attended a game of palm in the ditches of the Château d'Amboise. The 27-year-old King suddenly collapsed and became comatose. He laid down, almost on his own, on a straw mat that was hastily arranged, and he died 9 hours later. His contemporaries perceived his death as a perfect reminder of fatality: a king could die alone in a miserable gallery. All who looked into this curious death had dwelled on the frontal blow to head that the king had sustained right before his demise and had not considered alternative scenarios. The present study, still with limited available evidence, aimed to reexamine the historical account of his death in light of modern medical knowledge. It is virtually impossible that a minor bump with low kinetic energy could kill a 27-year-old man. Many historical accounts of Charles VIII's life and death, including Italian ambassadors' letters, led us to reconsider the commonly held version and to propose an alternative hypothesis. We have concluded that Charles VIII had experienced an acute consciousness disorder with language impairment that could have been related to an epileptic condition secondary to neurosyphilis. We have discussed whether a more accurate diagnosis for the cause of death could be obtained by a pathological analysis of the King's remains.

Scleroderma's Possible Dual Role in the Pathophysiology of Intracranial Aneurysms: Case Report and Literature Review

BACKGROUND

Scleroderma, or systemic sclerosis, is an autoimmune disorder affecting connective tissues, including blood vessels. Although the exact mechanism is not understood, it results in the production of an abnormal amount of collagen. Cases have been reported in which patients with scleroderma also had intracranial aneurysms. We wish to gain insight into any potential association between the 2 diseases.

CASE DESCRIPTION

We reviewed the literature of scleroderma cases with cerebral aneurysms and added our own case, focusing on patient and aneurysm characteristics. Including the present case, this paper pertains to 11 cases with 26 aneurysms. Fifty-five percent had multiple aneurysms, of which two thirds had >2. When data were available, 35% of aneurysms were ≥1 cm, 12% of which were giant. Four aneurysms were fusiform (15%). Patients presented with subarachnoid hemorrhage in 45% of cases.

CONCLUSIONS

Scleroderma may lead to the formation of an aneurysm, and the abnormal growth of collagen may protect it from early rupture, allowing it to reach a large size.

Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes

Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017. A total of 288 publications describing 1191 patients with IIA (1398 aneurysms) were included and reviewed for epidemiological features, disease features, treatment and outcome. All patients were merged into a single cohort and summary data are presented. The majority of reported IIAs are distally located, relatively small (<5 mm), involve the anterior circulation, are associated with a relatively high rate of rupture, and demonstrate a propensity to multiplicity of aneurysms. Sensitive diagnosis of IIAs requires digital subtraction angiography and not CT angiography or MR angiography. Treatment of ruptured, symptomatic, or enlarging IIAs has evolved over the last 50 years. Endovascular therapy is associated with a high success rate and low morbidity compared with microsurgical and medical management. A treatment algorithm for the management of patients with IIA in various contexts is proposed and the need for prospective multicenter studies is emphasized.