Neurosyphilis and diffuse cerebral angiopathy

On the basis of positive serum and spinal fluid serology, suggestive angiographic findings, and response to antibiotic therapy, a diagnosis of meningovascular syphilis was made in a 42-year-old man with right hemiparesis and asphasia of gradual onset. Angiography showed smooth concentric narrowing of the distal internal carotid arteries as well as narrowing and/or occlusion of the anterior and middle cerebral arteries and their branches. These angiographic findings can be differentiated from those associated with atherosclerotic vascular disease and correlate well with the usual pathologic features of meningovascular syphilis. The increasing incidence and frequent atypical presentation of syphilis underscore the importance of considering this diagnosis in patients with focal neurologic disease or suggestive angiographic findings.