42 Neurological involvement accounts for up to 5% of extrapulmonary TB, especially in children and/or immunodeficient patients.43 There are different reports about the incidence of stroke in neurotuberculosis. Dastur et al.44 reported cerebral infarction in 41% of 100 autopsied brain. In post-computer tomography era the reported incidence is between 28 to 38% without any prominent sex Inhibitors,research,lifescience,medical dominance.45,46 The highest rate of vascular infarction during TBM, diagnosed by MRI, is reported more than two thirds of the patients.47 Ninety-two percent of the involved arteries were in the anterior
cerebral circulation (carotid system).43,46 Lenticulostriate arteries of both middle and anterior cerebral arteries are mostly involved. Large infarctions are mainly due to middle cerebral
artery involvement, and brainstem infarction is due to occlusion of penetrating Inhibitors,research,lifescience,medical branches of basilar artery.46,48 A recent report showed that the hazard ratio of ischemic stroke for tuberculosis patients (not meningeal or CNS tuberculosis) was 1.52-times (95% CI, 1.21-1.91; P<0.001) higher than that for control group.49 The current guidelines for treatment Inhibitors,research,lifescience,medical are based on the advances of the recent chemotherapeutic achievement of anti-TB drugs,50 and medical or surgical management for ischemic strokes. Early treatment is mandatory, and delayed treatment is associated with a higher rate of mortality and morbidity. Inhibitors,research,lifescience,medical Dexamethasone appears useful as an adjunctive treatment, especially in patients with severe tuberculous meningitis. Syphilis Syphilis is the great masquerader. Two types of symptomatic neurosyphilis, paranchymatous and meningovascular have been described.42,51
About 5% of untreated syphilitic patients will develop neurosyphilis,52 especially in young adults. Two different types of vascular pathology have been described in meningovascular syphilis. Hübner arteritis, which Inhibitors,research,lifescience,medical had been described since long times ago, is the most common type and involves the large and medium sized vessels. The other pathology is Nissl’s endarteritis characterized by intimal and adventitial proliferation, mainly on small vessels.1 Mostly middle almost cerebral artery is affected.41 Different types of atherosclerotic plaques have been reported, but it should be defined that the presence of such lesions in neurosyphilitic patients does not imply a Selleck AZD2014 cause-and-effect relationship.53 Neurological manifestations consist of motor and sensory impairment, and relate to the size and location of the lesion. Syphilis can affect any part of the neuraxis. A high index of clinical suspicion requires early diagnosis and treatment of neurosyphilis, particularly in patients with promiscuous sexual activity.54 However, in HIV positive patients, the diagnosis and treatment of neurosyphilis is challenging.