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0936 The curious case of the shepherd and the dogs severe acute meningovasculitis: return of the great imitator

Journal of neurology, neurosurgery and psychiatry, 2017-12, Vol.88 (Suppl 1), p.A11-A12 [Peer Reviewed Journal]

2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions ;Copyright: 2017 © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions ;ISSN: 0022-3050 ;EISSN: 1468-330X ;DOI: 10.1136/jnnp-2017-ABN.33

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  • Title:
    0936 The curious case of the shepherd and the dogs severe acute meningovasculitis: return of the great imitator
  • Author: Jaffer, Fatima ; Ashraghi, Mohammad ; Nadarajah, Ramesh ; Sibtain, Naomi ; Britton, Tom
  • Subjects: Antibiotics
  • Is Part Of: Journal of neurology, neurosurgery and psychiatry, 2017-12, Vol.88 (Suppl 1), p.A11-A12
  • Description: A 40-year-old male presented as a wake-up stroke with right hemiparesis and aphasia consistent with a left MCA territory infarct. Rapid deterioration within 24 hours resulted in intubation thought to be secondary to malignant MCA syndrome. Within 48 hours, he had acquired new, multi-territory infarcts leading to tetraparesis. Initial ‘routine’ young stroke work-up was unyielding. MRI/MRA suggested vasculitis and CSF analysis revealed raised protein, lymphocytosis, and low glucose ratio with negative gram stain, culture and virology. HIV test was negative. Broad-spectrum antibiotics were commenced with anti-TB cover, pending results. Steroids were administered given diagnostic uncertainty whilst empirical treatment with cyclophosphamide was considered. Interval MRI at one-week post treatment showed significant improvement in vasculitis prompting testing for syphilis. Revisiting the history, the patient was in a same sex relationship and had a prodrome of increasing headaches, anorexia, insomnia, personality change and a palmar rash diagnosed as contact dermatitis, eight weeks prior to admission. Neurosyphilis was confirmed: serum RPR 1:32, TPPA>1:1280, positive EIA; CSF RPR 1:8 and TPPA>1:1280. He was treated with an extended course of antibiotics with slow improvement. We review the challenges in reaching a diagnosis and the latest BASHH guidelines – in this increasingly prevalent disease.
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 0022-3050
    EISSN: 1468-330X
    DOI: 10.1136/jnnp-2017-ABN.33
  • Source: ProQuest One Psychology
    ProQuest Central
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