A Stroke in the Young with Surprising Recovery

  • Dor Cohen Department of Internal Medicine T, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  • Gila Shpitalni Department of Internal Medicine T, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel and St. George’s, University of London School of Medicine, delivered by Nicosia University at the Chaim Sheba Medical Center, Tel Aviv, Israel
  • Yulia Lifshitz Department of Internal Medicine T, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  • Sapir Anani Department of Internal Medicine T, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  • Ana Eyal Department of Diagnostic Imaging, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  • Gad Segal Department of Internal Medicine T, Chaim Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel and St. George’s, University of London School of Medicine, delivered by Nicosia University at the Chaim Sheba Medical Center, Tel Aviv, Israel

Keywords

Stroke in the young, neurosyphilis, AIDS, HIV, syphilis, HCV

Abstract

Introduction: The differential diagnosis of stroke in a comparatively young adult should always include cardiovascular aetiologies as well as central nervous system infection.
Case Presentation: A 56-year-old man, with no significant medical history, presented with headache, nausea and vomiting, and right hemiparesis. Routine stroke investigation was initiated, while CNS infection was also sought. Diagnoses of HIV infection, neurosyphilis, HCV and HBV were established. Targeted therapy resulted in prompt clinical improvement.
Conclusion: This case highlights the importance of considering CNS infection as a cause of neurological deficits in parallel with other investigations in cases of stroke in a comparatively young adult.

References

  • Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag 2015;11:157–164.

  • Eilam A, Grin D, Avishay S, Gilad R. Neurosyphilis presenting with a stroke-like syndrome. J Neuroinfect Dis 2017;8:254.

  • Jameson JL, Kasper DL, Longo DL, Fauci AS, Hauser SL, Loscalzo J, editors. Harrison’s principles of internal medicine, 20th ed. New York: McGraw-Hill Education; 2018, p. 1145–1446.

  • Jan K, Min RHH, Yen TS, Singh SR. Ischemic stroke in an HIV positive patient: an initial presentation of neurosyphilis. Case Rep Neurol Med 2018;2410154.

  • Katelaris AL. Medial medullary stroke due to neurosyphilis in a newly diagnosed HIV-positive man. Intern Med J 2018;48:992–995.

  • Benjamin LA, Bryer A, Emsley HCA, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol 2012;11(10):878–890.

  • Nagappa M, Sinha S, Taly AB, Rao SL, Nagarathna S, Bindu PS, et al. Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital. Neuroradiology 2013;55(4):379–388.

  • Ahbeddou N, El Alaoui Taoussi K, Ibrahimi A, Ait Ben Haddou EH, Regragui W, Benomar A, et al. Stroke and syphilis: a retrospective study of 53 patients.Rev Neurol (Paris) 2018;174(5):313–318.
  • Published: 2019-05-24

    Issue: Vol 6 No 5 (view)

    Section: Articles

    How to cite:
    Cohen, D., Shpitalni, G., Lifshitz, Y., Anani, S., Eyal, A., & Segal, G. (2019). A Stroke in the Young with Surprising Recovery. European Journal of Case Reports in Internal Medicine, 6(5). https://doi.org/https://doi.org/10.12890/2019_000200