Stroke and Seizures as First Clinical Symptoms of Neurosyphilis: a Case Report

Here, we discuss the clinical case of a 45-year-old woman admitted to our hospital. This clinical case gave us the opportunity to face a forgotten disease [Drago et al. Eur Acad Dermatol Venereol. 1; Steenberg Schnohr et al. J Infect. 2; 86(5):P439–45], whose incidence is nowadays increasing. We would like to underline the importance to take into account rare diseases in diagnostic assessment. The woman came to our Emergency Room because of seizures. She had been affected by a stroke the year before [Drago et al. Eur Acad Dermatol Venereol. 1; Ahbeddou et al. Rev Neurol (Paris). 3;174(5):313–8]. A deepened examination showed us that the woman’s cognitive assessment was impaired. We performed laboratorial and radiological evaluations that led us to diagnose neurosyphilis (NS) [Marra. Contin: Lifelong Learn Neurol. 4:1714–28]. Her conditions improved after treatment. The exams performed showed us minimum amyloid-beta 42 (Aβ42) reduction with normal CSF tau levels and thiamine concentration critical reduction [Bian et al. J Bacteriol. 5;197(7):1164–72]. Deepening these results, we discover the possible role of Aβ42 as NS progression marker [Luo et al. Eur J Neurol. 6;22(5):853–8], and its hypothetic participation in neurological damage because of thiamine sequestration by Treponema Pallidum. We would like to underline the importance of a complete investigation in case of young people affected by stroke in particular, without clear explanations, taking into account even unusual nowadays disease. We suggest a possible evaluation of this disease using serological and CSF markers recently validated in scientific landscape, to improve diagnostic and thus therapeutic approach.