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Meningovascular syphilis causing recurrent stroke and diagnostic difficulties: a scourge from the past
  1. Sunil Munshi,
  2. Senthil K Raghunathan,
  3. Ileana Lindeman,
  4. Ashit K Shetty
  1. Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Dr Sunil Munshi, sunil512{at}


We describe a case of a 49-year-old man who presented with recurrent strokes in the left middle cerebral artery territory, manifesting with dysphasia, higher cognitive deficits, motor deficits and subsequent infarcts in the right middle cerebral and anterior cerebral artery territories, manifesting with seizures, behavioural and social issues. A key issue of the case was the diagnostic difficulty faced by the physicians. ‘Meningovascular syphilis’ was subsequently confirmed and appropriate treatment was given but there was subsequent relapse with worsening of the symptoms. Multiple specialists were involved in the management, namely stroke team, neurologists, psychiatrists, infectious disease and multidisciplinary therapy teams. This case highlights the need to be vigilant to the resurgence of syphilis, a scourge from the past, as a cause of stroke, especially in individuals who have had exposure to affected people. It is easy to miss the diagnosis and mistake it for other conditions unless a detailed history is taken and appropriate investigations are conducted, with a low threshold for diagnosis.

  • stroke
  • infection (neurology)
  • syphilis

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  • Contributors SM diagnosed and treated the patient, conceived the idea of publication and made the initial draft and checked the final draft. SKR helped in writing the case report and discussion. IL helped in the literature search and writing up the discussion. AKS ensured accuracy of the facts, reporting the scans and helped in the management of the patient and writing the case history and discussion. All are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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