This is a 54-year-old male patient, with a history of hypertension for two years before, without pharmacological management, and alcoholism, who presented a clinical picture of sudden onset of sensation of dizziness; four hours later he presented dysarthria.
Patient was admitted to the emergency department with blood pressure of 120/70 mm Hg and heart rate of 100 per minute; the rest of the general physical examination was normal.
He was alert, oriented in person, time and space, with dysarthria, without alterations in the mental sphere, without meningeal signs; there were no alterations in the skull or in the vertebral column; there were no alterations in the dynamic palatal velum
He had left hemiparesis, with decreased strength in the upper limb (3/5) and lower limb (4/5), with symmetrical generalized hyperreflexia, with neutral left plantar response and contralateral hand flexion change postural action.
A computed tomography (CT) of the skull showed a hypodense, lacunar lesion in the internal capsule.
That same day, a brain magnetic resonance imaging (MRI) was performed in which an extensive pontic infarction was observed, with critical stenosis of the basilar artery and thrombosis of the left anterior vertebral artery, without lesions in the circulation.
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Endovascular treatment showed complete stenosis of the lower third of the basilar artery, without distal flow, and a stent was placed without complications, remaining with a residual stenosis of 24 %.
During hospitalization studies for stroke were performed and it was found that the patient was negative for HIV, serum VDRL was positive (1:256) with FTA-ABS ruling out central nervous system involvement.
Pleocytosis was found in 65 leukocytes per mm3 with 10 % polymorphonuclear and 90 % mononuclear, glucose 71 mg/dl, proteins 33 mg/dl and a reactive VDRL (1:2).
With these findings the diagnosis of neurosyphilis was confirmed and treatment was initiated with 24 million units of crystalline penicillin daily for 21 days.
During his stay in the intensive care unit, the patient required orotracheal intubation due to the risk of airway compromise due to his cerebral stem infarction.
She had a late pneumonia associated with the ventilator by Serratia marcescens, for which she received antibiotic treatment without complications.
During hospitalization, the functionality of the medullary cranial nerves was not affected; therefore, it was necessary to perform a tracheostomy and gastrostomy.
Before discharge, a new lumbar puncture was performed in which a significant decrease in pleocytosis and proteinorrhachia was found; however, the VDRL was reactive (1:8), probably due to the treatment.
She was discharged with dysarthria, supranuclear gaze palsy, left hemiparesis, fistula, percutaneous gastrostomy and dual outpatient management with antiplatelet therapy.
