Bagatti Davide, Mazibrada Jasenka, Ligarotti Gianfranco Kim Innocente, Nazzi Vittoria, Franzini Angelo
Department of Neurosurgery III, Foundation of the "Carlo Besta" Neurological Institute, IRCCS, Milan, Lombardy, Italy.
Department of Neuropathology, Foundation of the "Carlo Besta" Neurological Institute, IRCCS, Milan, Lombardy, Italy.
World Neurosurg. 2016 Mar;87:662.e13-8. doi: 10.1016/j.wneu.2015.10.085. Epub 2015 Nov 5.
Although syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult.
We report the case of a 41-year-old African man affected by neurosyphilis that manifested itself through a meningovascular chronic inflammatory process, with the peculiar feature of a bilateral aneurysm of probable mycotic origin involving the distal tract of A2 segment of both anterior cerebral arteries.
Because of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.
尽管自第二次世界大战以来梅毒在西方世界已成为一种罕见疾病，但据信在1999年有1200万人感染梅毒，其中超过90%的病例发生在发展中世界。此外，自2000年以来，美国、英国、澳大利亚和欧洲的梅毒发病率一直在上升。由于该疾病具有隐匿性，且其晚期表现的总体发生率较低，可能难以做出准确诊断。
我们报告了一例41岁非洲男性患神经梅毒的病例，该病例表现为脑膜血管慢性炎症过程，其独特特征是双侧动脉瘤，可能为霉菌性起源，累及双侧大脑前动脉A2段的远端。
由于梅毒（尤其是晚期梅毒）临床表现大多不具有特异性，因此容易伪装成许多其他疾病，即使是经验丰富的医生也可能觉得其诊断颇具挑战性；因此，对于所有认知障碍病例，在进行全面的临床和影像学检查时，应辅以梅毒血清学检测。与神经梅毒相关的霉菌性颅内动脉瘤鲜有报道；然而，它们需要早期诊断和精心的个体化治疗。鉴于梅毒发病率似乎在上升，有必要对该主题进行进一步研究。
