Asunto(s)
Enfermedades Autoinmunes del Sistema Nervioso/etiología , Infecciones por Coronavirus/complicaciones , Delirio/etiología , Encefalitis Viral/etiología , Neumonía Viral/complicaciones , Convulsiones/etiología , Anciano , Enfermedades Autoinmunes del Sistema Nervioso/diagnóstico , Enfermedades Autoinmunes del Sistema Nervioso/terapia , Betacoronavirus , Encéfalo/diagnóstico por imagen , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Delirio/diagnóstico , Delirio/terapia , Imagen de Difusión por Resonancia Magnética , Encefalitis Viral/diagnóstico , Encefalitis Viral/terapia , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , SARS-CoV-2 , Convulsiones/diagnóstico , Convulsiones/terapia , Estado Epiléptico/diagnóstico , Estado Epiléptico/etiología , Estado Epiléptico/terapiaRESUMEN
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.