Summary of case

A 40-year-old right-handed male with a past medical history of HIV well-controlled on antiretrovirals (last CD4 count 834, absent viral load) presented with headaches, memory changes, and 2 days of right-sided numbness and weakness.

He had gradual onset of intermittent headaches over the last month. The headaches were throbbing and, at times, holocephalic. The severity of the headaches worsened over the course of a month. There were no clear triggers to these headaches or preceding aura. There was no associated nausea or vomiting or positional component. The patient has no prior history of headaches. Two days prior to admission, the patient awoke with right-sided numbness and weakness that started in his arm and leg. He noted difficulty writing with his right hand. His friend noted that the patient had been slurring his words in the last 2 days and also that the patient appeared confused over the same time course (Figs. 1–3-1–3).

An MRI on admission demonstrated multifocal acute infarcts and areas of enhancement. A lumbar puncture demonstrated a positive CSF VDRL, concerning for meningovascular syphilis. The patient was treated with 14 days of penicillin and his symptoms of headache and fatigue improved significantly. He underwent physical therapy for his right-sided weakness. After the initiation of treatment, he denied any new neurologic symptoms. Meningovascular syphilis is more common in HIV and often is preceded by a prolonged prodrome of headache, confusion, and meningismus, such as in our patient.

中文翻译：

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40岁男性头痛、记忆力改变、急性缺血性中风一例

案例总结

一名 40 岁的右利手男性，既往有 HIV 病史，抗逆转录病毒药物控制良好（最后 CD4 计数 834，无病毒载量），出现头痛、记忆改变和 2 天右侧麻木和无力。

在过去的一个月里，他逐渐出现间歇性头痛。头痛在跳动，有时是全头性的。在一个月的时间里，头痛的严重程度恶化了。这些头痛或先兆前兆没有明确的诱因。没有相关的恶心或呕吐或体位成分。患者既往无头痛病史。入院前两天，患者醒来时发现右侧麻木和无力，从他的手臂和腿开始。他注意到右手书写困难。他的朋友指出，患者在过去 2 天里一直口齿不清，而且患者在同一时间段内似乎很困惑（图 1-3-1-3）。

入院时的 MRI 显示多灶性急性梗塞和强化区域。腰椎穿刺显示 CSF VDRL 阳性，与脑膜血管梅毒有关。患者服用青霉素 14 天，头痛、乏力症状明显改善。他因右侧虚弱而接受了物理治疗。在开始治疗后，他否认有任何新的神经系统症状。脑膜血管性梅毒在 HIV 中更为常见，并且通常先于长期的头痛、精神错乱和脑膜炎前驱症状，例如在我们的患者中。