Stroke secondary to syphilis

Definition

Stroke is life-threatening complication of a long-term syphilis infection.

Alternative Names

Causes, incidence, and risk factors

Untreated, late-stage tertiary syphilis can cause inflammation and blockage of the arteries that supply the brain. A stroke is an interruption of the blood supply to any part of the brain. Stroke can lead to brain tissue damage.

Symptoms

The following symptoms may occur about 1-4 weeks before the stroke:

• Headache
• Vertigo (abnormal sensation of movement)
• Behavioral changes
• Irritability

• Weakness or the total inability to move a body part
• Numbness, tingling or other abnormal sensations
• Decreased or lost vision, partial or temporary
• Language difficulties (aphasia)
• Inability to recognize or identify sensory stimuli (agnosia)
• Loss of memory
• Vertigo (abnormal sensation of movement)
• Loss of coordination
• Swallowing difficulties
• Personality changes
• Mood and emotion changes
• Urinary incontinence (lack of control over bladder)
• Lack of control over the bowels
• Consciousness changes
  • Drowsiness
  • Fatigue
  • Loss of consciousness

Signs and tests

The doctor will ask if you have a history of syphilis. Blood tests can be done to check for substances in the blood produced by the bacteria that causes syphilis. These include:

• Venereal disease research laboratory test (VDRL)
• Rapid plasma reagin test (RPR)

If tests are positive, other tests are done to confirm the diagnosis. A spinal tap may be done to check for syphilis-related substances in the CSF (cerebrospinal fluid).

The following tests may be used to determine the location and severity of the stroke:

• Head CT scan
• Head MRI scan
• Angiography of the head or neck

Treatment

For stroke treatment, see the article on stroke.

Antibiotics are used in high doses to treat the syphilis infection. Pain killers may be needed to control severe headaches.

Expectations (prognosis)

The outcome depends on the extent of damage to the brain, the presence of other complications of late syphilis, and other factors.

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have any symptoms of a stroke.

Prevention

Stroke secondary to syphilis may be prevented by receiving prompt treatment and follow-up care for syphilis.

References

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: Saunders; 2004.