Meningovascular Syphilis Presenting as Acute Ischemic Stroke in an HIV + Young Adult: A Case Report and a Brief Literature Review.

Background: Meningovascular syphilis, a distinct classification of neurosyphilis, has gained attention for its association with cerebral ischemia, particularly among individuals living with HIV. This unique manifestation of syphilis affects the meningeal and vascular structures of the central nervous system, leading to cerebrovascular complications. In this case report, we present the case of a young man diagnosed with neurosyphilis and HIV after presenting with an ischemic stroke. We discuss the challenges associated with diagnosing neurosyphilis, given its frequent atypical presentations that can mimic other diseases. Furthermore, we explore the management approach for these coexisting conditions. Case Presentation: A right-handed male patient presented with a sudden paresis of the right upper and lower extremities, along with facial deviation to the left, and demonstrated low verbal output, limitation in constructing sentences, and conveying thoughts or ideas effectively. Upon admission, the patient's neurological examination revealed a FOUR coma scale of 16. He exhibited motor aphasia, right facial paralysis sparing the forehead, and right upper and lower extremity spastic hemiparesis with a strength of 3 out of 5 on the Medical Research Council scale. The Plantar reflex was positive on the affected side. Brain magnetic resonance imaging revealed left middle cerebral artery infarction (cortical and lenticulostriate territory acute infarction). Conclusion: This case highlights the need for treating physician to have a high index of suspicion towards meningovascular syphilis as a potential cause of stroke in young individuals. This is crucial, especially when there is also a concurrent HIV infection, as it requires specific treatment.

Challenges Faced and Lessons Learned: The Journey of a 22-Year-Old Male with a Mechanical Heart Valve Complicated by Ischemic Stroke in a Developing Country: A Sub-Saharan Africa Prospect.

This report reviews an Ethiopian patient who underwent cardiac surgery and had a mechanical heart valve implanted on the mitral valve with tricuspid valve repair for rheumatic heart disease via a local non-profit organization donation later complicated by cardio-embolic stroke, and aims to describe the challenges faced by patients from rural Ethiopia who require cardiac surgery for rheumatic heart disease and narrate the importance of careful follow-up. The lessons to be drawn from this case are that careful follow-up and adherence to prescribed Vitamin K antagonists after surgery for mechanical heart valves are critical and, when such patients are lost to follow-up as was witnessed in this case, it can induce lifelong morbidity. Morbidity that could have been avoided with strict and meticulous follow-up and with standardized patient tracing or contact systems. When patients are lost to follow-up it needs to be top priority to trace them after cardiac surgery and this report highlights the pivotal role of the health education in such populations. Unless we utilize this opportunity to unlock the door and embrace a systemic approach to reforming our risk assessment, referral chain system, and integration of various healthcare professionals in patient follow-up, as well as enhancing health education among our patients in rural Ethiopia and other low-income countries, the consequences could prove to be significant. Preventing such fatal complications is far superior to managing them afterwards, as it not only saves on expenses but also saves lives and enhances quality-of-life.

Case Report: A Closed Loop Obstruction Secondary to Idiopathic Small Bowel Intussusception in an Elderly Woman.

Intussusception is primarily a disease of children and is the primary cause of intestinal obstruction in the pediatric age group. It accounts for around 5-16% of cases of intestinal obstruction in adults of the western population. Most cases of adult intussusception (up to 90%) are secondary to an identified structural lesion or a lead point contrary to pediatric intussusception. Adults with intussusception present with subacute or chronic symptoms of partial obstruction. CT is the best imaging to make a preoperative diagnosis of adult intussusception. The standard treatment for adult intussusception is surgery, and non-operative reduction should not be attempted. Here, we present a rare case of idiopathic small bowel intussusception in a 50-year-old woman. She presented with crampy abdominal pain for one-week duration. It was associated with frequent vomiting of bilious matter. She claimed to have had similar symptoms for the past 2 months and had repeatedly visited nearby health facilities. She had an abdominal CT, which suggested a complicated small bowel intussusception. Exploratory laparotomy was done, and there was a small bowel intussusception and an inflammatory stricture at the end of the intussusceptum, which is believed to form a closed-loop like obstruction. The intussusceptum was resected en-bloc then end-to-end jejuno-jejunal anastomosis was performed. This case report makes physicians aware of this rare condition in adults. So that they have a high index of suspicion when a patient presents with symptoms of subacute or chronic intestinal obstruction and inform that abdominal CT should be done in these circumstances and surgery is the mainstay of treatment. Our case is unique, and there is no report in the literature similar to ours.

A Rare Case of Intestinal Tuberculosis with Chronic Partial Small Bowel Obstruction in a 37-Year-Old Ethiopian Man.

Tuberculosis (TB) is a chronic granulomatous inflammatory disease that affects any part of our body. TB is a significant problem in developing countries. Intestinal TB accounts for 2% of TB cases worldwide. Terminal ileum and cecum are the two commonly affected regions because of abundant lymphoid tissue, physiologic stasis, limited digestive activity and increased fluid and electrolyte absorption rate. Intestinal obstruction is the leading complication of intestinal TB, and it occurs because of intestinal luminal narrowing, multiple strictures or adhesions. The clinical presentation of patients with intestinal TB and post-TB intestinal obstruction is non-specific. It can be acute, chronic, or acute on chronic. Uncomplicated cases of intestinal TB can be managed medically. Surgery is reserved for complicated cases of intestinal TB, which includes peritonitis, intestinal obstruction and perforations. Here, we present a 37-year-old man who presented with long-standing, intermittent crampy abdominal pain and vomiting. He was diagnosed with chronic partial small bowel obstruction secondary to possibly small bowel carcinoma. We did segmental ileal resection and end-to-end ileo-ileal anastomosis. Postoperatively, the histopathology result turned out to be intestinal TB. This case report aims to make physicians aware of the rare condition of small bowel obstruction secondary to intestinal TB. Clinicians need to have a high index of suspicion in any patient with long-standing symptoms of partial obstruction and consider surgery and anti-TB once diagnosed.