Zhang Ping, Chen Lei, Chen Shiyue, Wu Tao, Zhang Yongwei
Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
Department of Imaging, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
Sex Health. 2023 Feb;20(1):80-82. doi: 10.1071/SH22147.
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.
We report a rare case with severe isolated middle cerebral artery (MCA) stenosis and cerebral infarction, which was evaluated by serial HR-VWI.
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.
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.
梅毒性血管炎（SV）较为罕见且难以诊断。高分辨率血管壁磁共振成像（HR-VWI）通过区分SV与其他血管壁病变，在诊断中可能具有重要价值。
我们报告了一例罕见的严重孤立性大脑中动脉（MCA）狭窄及脑梗死病例，该病例通过系列HR-VWI进行评估。
一名46岁女性出现左侧基底节急性梗死及左侧大脑中动脉（MCA）严重孤立性狭窄。进行了脑脊液（CSF）分析，结果与神经梅毒诊断相符。MCA狭窄也被怀疑是SV所致。HR-VWI显示动脉壁呈同心性增厚及环形均匀强化。经过两个周期的抗梅毒治疗后，后续的HR-VWI显示MCA狭窄明显减轻，动脉壁仅有轻微强化，这证实了SV导致了孤立性MCA狭窄。
HR-VWI可能是诊断由SV引起的孤立性大脑中动脉狭窄的重要工具，未来可作为评估抗梅毒治疗反应的生物标志物。
