Ardelean, Gavril - Buicu, Florin (szerk.): Satu Mare. Studii şi comunicări. Seria ştiinţele naturale 8. (2007)
Medicină
NEUROSYPHILIS - A CASE PRESENTATION GS. Ţ1PUCA’ 2 Carmen SÂLĂ VASTKU'2 Alina PÂRVU’, Alina RUŞINOIU Magdalena CONSTANTIN’ 2, Mihaela PANDURU’, S.H. MORARIU3 1 - Second Cänic of Dermatology, Colentina Hospital Bucharest, 2 - „Carol Davila" University of Mediane and Pharmacy, 3 - University of Mediane and Pharmacy Targu Mum Summary Syphilis is representing a global health problem. More than 12 million people are infected each year. Treated as a public health problem by the Ministry of Pubic Health syphilis prevalence In Romania is showing a decrease: from 12,702 cases in 2002 to 5,657 syphilis cases in 2006. Some patients are diagnosed in advanced stages of the disease as neurosyphilis. A 38 years old male with generalized convulsive seizures and other neurological manifestations was spotted with Treponemapaüidum infection. Benzyl penicillin in large doses was administered and Benzathine benzyl penicillin was sequent used. The neurological disorders improved. Neurosyphilis is not a rare manifestation of Treponema infection and must be a differential diagnosis in all patients with seizures. Key words: Neurosyphilis, Generalized seizures, Benzyl penicillin Introduction Syphilis has an impressive historical importance and has played a major role in medicine over many decades. Searching to understand syphilis emerged in important contributions to epidemiology, clinical practice, pharmacology, neurology, pathology, bioethics and history. As secret files are brought to light it is better understood that syphilis has had a prominent influence in history and literature for the last several hundred years. For example the presence of neurosyphilis can be explanatory for Lenin’s important changes in attitude recorded during his public life. Whispers have circulated for decades that Lenin, founder of the Bolshevik Party, was afflicted with syphilis throughout his career. Lenin's illness at least mimicked the progression of syphilis, afflicting him for months with occasional seizures and excruciating headaches, as well as bouts of nausea, sleeplessness and partial paralysis. As Stalin plotted for control of the Communist Party, Lenin was alternately lucid and incapacitated. Sometimes, he was unable to walk without assistance or to speak. It is thought that Lenin was suffering from meningovascular syphilis on his deathbed [1]. Neurosyphilis refers to a site of infection involving the central nervous system. Neurosyphilis may occur at any stage of syphilis. Before the age of antibiotics, it was typically seen in 25-35% of patients with syphilis. Case report We present the case of 38 years old G. C. who was admitted in the Dermatology Clinic of Colentina Hospital for positive serology (VDRL and TPHA). The patient was transferred from the Neurology Clinic were he presented for generalized convulsive seizures, drowsiness and confusional state. The Satu Mare - Studii şi Comunicări Seria Ştiinţele Naturii Voi VIII (2007) pp: 72 - 74 patient described another convulsive seizure in 2006, which was investigated at that time; die MRI from 2006, showed a small lacunar image in the right mesencephalon. In the recent past medical history the patient denied any cutaneous and/or mucous lesions. Social history revealed a married patient with apparently harmonious family environment and work place (he work as automechanic). Physical examination discovered a good general state, without fever, blood pressure of 100 / 70 mmHg, and heart rate of 82 b / min. No cutaneous or mucous lesions were identified and palpation did not identify any enlargements of peripheral lymph nodes. The paraclinical investigations performed illustrated a mild inflammatory syndrome. The hemogram showed neutrophilia (14,9xl03 p/1) with lymphcytopenia (0.43xl03 p/1),: ESR=28 mm/h, negative HIV test ( anti-HIV 1 antibodies, anti- HIV 2 antibodies were absent), serum VDRL was positive at a titer of 1/16, TPHA ++++. The cerebro-spinal-fluid (CSF) demonstrated VDRL ++, TPHA ++++. CSF further examination showed 45 lymphocytes / mm3, no RBCs, no macroscopic sediment, slightly positive Pandy reaction. A MRI examination was performed during the admission in the Clinic of Dermatology and there were identified bilateral temporal parenchymatous lesions. The differential diagnosis for these lesions was made between vascular lesions (secondary to microvascular damage possible due to cerebrovascular accident (CVA)), and edematousinflammatory lesions (figure 1). The neurological consult showed a confuse, disoriented patient, without a stiff neck or bilateral pupillary reflexes. The patient hasn’t presented any
