Prevalence of clinical manifestations and neuroimaging features in cerebral small vessel disease

Background and purpose: Cerebral small vessel disease (CSVD) may present with gradual onset, chronic parkinsonism and/or dementia. In this study, we aimed to identify the prevalence and clinical characteristics of apathy, dementia and parkinsonism in a cohort of patients with CSVD and to determine the neuroimaging features in these patients. Methods: We included all patients with CSVD, who were admitted to the stroke outpatient clinic between February 2018 and February 2019. All patients were over 18 years of age. Demographic, clinical and neuoimaging findings were noted. Detailed neurological examination and neuropsychiatric assessments were done in each patient. The types and anatomical sites of lesions in neuroimaging were also determined. Results: Among all stroke patients in the study period, CSVD constituted 23.3%. The etiologies were possible arteriosclerotic, amyloid angiopathy and CADASIL in 85.0%, 3.3% and 11.7% of these patients, respectively. The most common clinical feature was apathy followed by dementia, parkinsonism, and parkinsonism plus dementia. In regression analysis, apathy and parkinsonism was associated with lesions in caudate or in other basal ganglia structures whereas lesions of corpus callosum increased the risk of dementia. Hypertension was also associated with the presence of dementia. There was no specific association between the type of lesion in neuroimaging and clinical findings. Conclusions: The risk of clinical manifestations such as apathy, dementia and parkinsonism is high in CSVD. Involvement of basal ganglia increased the risk of parkinsonism and apathy whereas involvement of corpus callosum increased the risk of dementia. A detailed assessment for apathy is necessary along with parkinsonism and cognitive findings since apathy is the most common finding in CSVD

A Case of Neurosyphilis Presenting with Multiple Cranial Neuropathy

Syphilis is a sexually-transmitted disease caused by the spirochete bacterium Treponema pallidum. Central nervous system involvement can occur in every stage of the disease. It is classified into: acute syphilitic meningitis, meningovascular syphilis, and parenchymatous neurosyphilis. Acute basilar syphilitic meningitis is characterized primarily by the presence of cranial nerve involvement. As cranial nerve enhancement may be seen in a broad range of diseases, it can be the only clinical feature of neurosyphilis