[Cerebral vasculitis with delirium in neurosyphyllis].
BACKGROUND
In a 40-year-old man with delirium, right-sided facial palsy and anisocoria (right > left) were noticed. He had been suffering from headaches for four weeks prior to admission. The patient's HI-virus status was positive and he used illicit drugs regularly. Therefore, the symptoms were initially thought to be drug-induced. EXAMINATION AND DIAGNOSIS: Laboratory tests showed a pleocytosis of the cerebrospinal fluid (CSF) with 929 cells/µl. The MRI of the brain revealed several ischemic strokes in the territories of the middle cerebral artery and posterior cerebral artery in the left hemisphere. A highly positive IgG CSF/serum index confirmed the diagnosis of neurosyphilis.


METHODS
An antibiotic regime with penicillin was administered, during which the clinical symptoms remitted and the liquor pleocytosis nearly normalized. The intracranial stenoses persisted for three months even after therapy with nimodipine, atorvastatin, and antibiotics. Therefore they are presumed to be a result of the lues-associated vasculitis.


CONCLUSIONS
In patients with delirium the initially suspected underlying condition needs to be challenged. Early cerebral MRI, lumbar puncture and ultrasound of the cerebral arteries are mandatory to exclude menigoencephalitis.
Neurologische Klinik, Dr. Horst Schmidt Kliniken GmbH, Wiesbaden.
F
F
Sextro
Neurologische Klinik, Dr. Horst Schmidt Kliniken GmbH, Wiesbaden.
J
J
Erceg
Neurologische Klinik, Dr. Horst Schmidt Kliniken GmbH, Wiesbaden.
G F
GF
Hamann
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D009494:Neurosyphilis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014665:Vasodilator Agents