Stroke secondary to syphilis

Alternative names
Syphilitic stroke

Definition
Stroke is a possible complication of syphilis infection. The stroke destroys blood vessels that supply the brain and results in a loss of brain function.

Causes, incidence, and risk factors
Stroke caused by syphilis occurs as a life-threatening complication of long-standing syphilis infection. The infection causes inflammation and blockage of the arteries which supply the brain. Decreased blood flow causes brain tissue damage from lack of oxygen (ischemia) and death of the tissues (infarction).

Risks include Tertiary syphilis infection.

Symptoms
Prodromal (early) symptoms may precede the symptoms of stroke for about 1 to 4 weeks. These are:

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

Symptoms of stroke include:

     
  • 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       o Drowsiness       o Fatigue       o Loss of consciousness

Signs and tests
A known history of syphilis may help to indicate syphilis as the cause of the Stroke.

Tests may be used to confirm syphilis as the cause of the stroke, including:

     
  • Venereal disease research laboratory test (VDRL) and rapid plasma reagin test (RPR) blood tests for antibodies. If tests are positive, other Antibody tests are done to confirm the diagnosis.  
  • CSF (cerebrospinal fluid) examination, showing positive CSF VDRL test, increased number of white blood cells, increased protein level, increased pressure of the fluid, or other abnormality.

The location and extent of the area of the brain involved in the stroke may be determined by:

     
  • Head CT scan  
  • Head MRI scan  
  • Angiography of the head or neck showing constriction or occlusion of the arteries

Treatment
Symptoms are treated as with any stroke. Physical therapy, occupational therapy and other rehabilitation measures may be needed. Antibiotics are used in high doses to treat the syphilis infection. Analgesics 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.

Complications

     
  • Complications of stroke  
  • Complications of syphilis

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 impending stroke.

Prevention
Stroke secondary to syphilis may be prevented by adequate treatment and follow-up for primary syphilis and secondary syphilis. Preventing the development of latent and Tertiary syphilis prevents progressive damage, not only to blood vessels, but to the brain, spinal cord, bones, heart, and other tissues.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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