Meningovascular Neurosyphilis Presenting as Ischemic Stroke in an HIV Positive Patient (P2.297)

OBJECTIVE: To elucidate the presentation of meningovascular neurosyphilis (MVNS) as an acute ischemic stroke (AIS). BACKGROUND: Neurosyphilis has a broad range of symptoms. Some clinical presentations MVNS may resemble AIS secondary to atherosclerosis. MVNS also often mimics the appearance of atherosclerosis on routine non-invasive cerebral vessel imaging modalities. DESIGN/METHODS: A 27-year-old male without known past medical history presented with right-sided hemiparesis and dysarthria. MR imaging revealed left thalamocapsular AIS, basilar artery (BA) occlusion, and absence of the left posterior communicating artery (PComm). Cerebral angiogram confirmed BA occlusion of the proximal one-third segment with the distal BA supplied by the right PComm. The BA lumen was irregular, suggestive of stenosis rather than thrombus. RESULTS: Repeat imaging confirmed previous findings plus new findings of a flow gap and severe narrowing of the right ICA terminus (ICA-T), M1, A1 segment origins; mild irregularity and narrowing of the left ICA-T, M1, A1 segment origins; flow gap of the left PCA P1 segment, respectively. Contrast images revealed vessel wall enhancement of both vertebral arteries suggestive of vasculitis. On clinical examination, anal condylomas were noted. RPR was positive, CSF VDRL was reactive, and HIV positive status was confirmed. The patient was treated with IV penicillin for neurosyphilis, which resulted in symptomatic improvement. Repeat post-contrast images revealed significant resolution of the newly discovered vessel abnormalities. CONCLUSIONS: MVNS should be considered in AIS patients without known risk factors, especially in patients who are HIV positive. Prompt treatment can halt progression of and possibly improve symptomatology. Diagnosis and improvement can be monitored with intracranial arterial wall imaging using contrast-enhanced MRI. Disclosure: Dr. Tipirneni has nothing to disclose. Dr. Gordon-Perue has nothing to disclose. Dr. DeSousa has nothing to disclose. Dr. Koch has nothing to disclose. Dr. Romano has received personal compensation for activities with NovaVision. Dr. Malik has nothing to disclose.