Kelley Roger E, Minagar Alireza, Kelley Bradford J, Brunson Regina
Department of Neurology, LSU Health Sciences Center, Shreveport, Louisiana, USA.
J Neuroimaging. 2003 Jan;13(1):85-7.
Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10-day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.
脑膜血管梅毒现在相当少见，但在感染人类免疫缺陷病毒而免疫功能低下的患者中，相关报道日益增多。梅毒累及中枢神经系统对抗生素治疗的反应仍然是一个挑战。对于存在潜在免疫系统损害的患者，这一挑战更为严峻。作者报告了一名46岁复发性中风男性患者，其脑脊液检查结果符合梅毒累及中枢神经系统，脑血管造影显示右侧大脑中动脉局灶性狭窄。经颅多普勒基线研究显示右侧大脑中动脉平均流速和峰值流速增加。尽管静脉注射青霉素治疗10天，脑脊液结果有显著改善，但在4个月的随访期内，这种流速升高以非常一致的模式持续存在。因此，治疗后受累血管仍保持通畅，但未观察到狭窄病变的明显缓解。
