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Show /oumal of Cllllical NCliro-ophthalmology 7(31:180-182, 1987. Letters to the Editor Dolicho-ectasia and Syphilis To the Editor: It is ironic that the March 1987 issue of the Journal of Clinical Neuro-ophthalmology, which contains three papers on syphilis and an editorial on the same subject, has an article regarding a syndrome frequently associated with syphilis and fails to report the results of a serologic test for that disease (1). In the article in which we coined the term dolicho- ectasia (2), we reported that, of the 22 patients upon whom serologic results were available, five were positive and three were equivocaL We also pointed out that the syndrome of dolicho-ectasia was frequently associated with aortic aneurysms and hypertension, both of which were present in the patient reported by Slavin and LoPinto. Joel G. Sacks, M,D, Department of Ophthalmology University of Cincinnati College of Medicine Cincinnati, OH REFERENCES 1. Slavin ML, LoPinto R]. Isolated environmental tilt associated with lateral medullary compression by dolichoectasia of the vertebral artery: Is there a cause and effect relationship? J Clin Neuro-ophthalmol 1987;7(1):29-33. 2. Sacks ]G, Lindenberg R. Dolicho-ectatic intracranial arteries: Symptomatology and pathogenesis of arterial elongation and distension. Johns Hopkins Med J 1969;125:95-106. Editorial Response The fact that of 22 patients with dolicho-ectatic intracranial arteries, five showed positive and three equivocal serologic tests for syphilis is certainly of interest. Presumably these were reagin (nonspecific) (VORL) tests, and not TPI or FTAABS (specific) tests. If we accept the five reactive tests as consistent with prior syphilitic infection ('!ld exclude any possibility of a biologic false pos- .1 ,'. " ',lid find a 23'){, incidence 180 © 1987 Raven Press, Ltd., New York of seroreactivity in those patients, If we accept all eight tests as pointing to prior syphilic infection, one would call that a 36% incidence of seroreactivity in those patients. It is of interest that in a study of 1,985 patients seen at the Bascom Palmer Eye Institute in Miami who had serologic testing between 1957 and 1963, that 718 had reactive FTAABS tests and 441 patients had reactive serum VORL tests. The FTA-ABS was thus reactive in 41% of all sera tested, and the VORL test was reactive in 22% of the sera tested-an almost identical incidence to the seroreactivity reported by Sacks and Lindenberg in their report. This study was reported by Harner et aL (1). The point to be made is that one must remember this disease and continue to get routine VORL or RPR tests on all admissions on ophthalmologic and neurologic services and order the serum FTA-ABS test with a high degree of suspicion in these patients. Whether or not there is a higher incidence of seroreactivity in patients with dolichoectasia than in other patients in the ophthalmic and neurologic clinics in the Baltimore population would require a controlled study to evaluate. Dr. Sacks certainly helps emphasize the importance of looking for syphilis, however! J. Lawton Smith, M.D. REFERENCES 1. Harner RE et al. The FTA-ABS in late syphilis. A serological study of 1,985 cases. JAMA 1968;203(8):545-8. Giant Cell Arteritis and Borrelia Infection To the Editor: I would like to test the hypothesis that a fraction of 'p'atien~s with giant cell arteritis (temporal artentIs) mIght have evidence of infection with the spirochete Borrelia burgdorferi or related Borrelia |