Post Meningioma Resection Complicated by Intracranial Hemorrhage in a Neurosyphilis Patient: A Case Report

Abstract

Case/Program Description: A 48-year-old woman with a medical history of uncontrolled hypertension, GERD, asthma, neurosyphilis and status post meningioma resection presented to the emergency room with complaint of headaches and lethargy for 2 days. The patient had a remarkable past surgical history of 30 days post-operative sphenoid meningioma resection with bilateral craniotomy and ongoing treatment of neurosyphilis with penicillin. Head CT performed secondary to altered mental status demonstrated right frontal intracranial hemorrhage and the patient underwent emergent craniotomy with hematoma evacuation without noted complication during surgery. CT angiography of the neck and brain was negative for intracerebral aneurysm and arteriovenous malformation. Coagul-opathy studies were negative. On the seventh day post-operative from the first hematoma evacuation the patient reported progressive bilateral vision loss. A CT was performed and demonstrated a left frontal intracranial hemorrhage. A second emergent craniotomy and hematoma evacuation was performed without complications. The patient was noted to have had poor vision deteriorating at baseline from optic atrophy secondary to the intracranial hemorrhage. Ophthalmology was consulted and noted optic atrophy as well as Adie syndrome of the eye. Her new functional state declined with severe cognitive deficits of memory, language, and attention with periods of agitation, confusion, and hallucinations. Setting(s): Traumatic brain injury unit of an inpatient rehabilitation facility. Result(s): The patient was admitted to the traumatic brain injury rehabilitation unit for functional deficits in mobility, transfers, ADL, and iADL. Discussion(s): Neurosyphilis has several complications one being meningo-encephalopathic syndrome which can cause severe cerebro-vascular or myelovascular issues. There are very few cases discussing the causation of intracranial hemorrhage by neurosyphilis. Patient was tested positive with FTA-ABS and was treated for the reoccurrence of syphillis. Conclusion(s): It is essential to understand the complications that arise from neurosyphilis and how to manage a patient with appropriate rehabilitation of new onset vision loss.