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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1131-1132

Neuroimage - Neurosyphillis


Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission26-Dec-2019
Date of Decision08-Dec-2020
Date of Acceptance12-Dec-2020
Date of Web Publication2-Sep-2021

Correspondence Address:
Amit K Bagaria
Room No. F-26, Resident Doctor's Hostel, SMS Medical College, Jaipur - 302 004, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325304

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How to cite this article:
Vyas A, Bagaria AK, Goel D, Mathur V. Neuroimage - Neurosyphillis. Neurol India 2021;69:1131-2

How to cite this URL:
Vyas A, Bagaria AK, Goel D, Mathur V. Neuroimage - Neurosyphillis. Neurol India [serial online] 2021 [cited 2021 Oct 22];69:1131-2. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1131/325304




A 45-year-old male patient with a history of change in behavior, aggressiveness, perseveration, inappropriate undressing, difficulty in calculation, handling money matters, and sexual promiscuity for the last 2 years followed by amnesia for the last 12 months. He had two episodes of stroke in past. He was mute with impaired comprehension at presentation. Examination showed left hemiplegia with bilateral brisk reflexes and extensor plantar. Magnetic resonance imaging was done which showed extensive white matter hyperintensities with bilateral anterior temporal lobe and external capsule involvement [Figure 1] and [Figure 2]. Serum Veneral disease research laboratory and Treponema pallidum hemagglutination assay were positive with negative Cerebrospinal fluid VDRL. CSF showed lymphocytic pleocytosis with raised proteins and normal sugar. Based on clinical pictures and laboratory data, neurosyphilis was considered and started on ceftriaxone for 2 weeks as crystalline penicillin was not available. There was a significant improvement in his mentation, cognition, and brain hyperintensities [Figure 3] and [Figure 4] after 12 months of follow-up.
Figure 1: MRI brain at admission S/O periventricular, temporal lobe hyperintensities

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Figure 2: MRI brain at admission S/O periventricular, anterior temporal lobe and insular hyperintensity

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Figure 3: MRI at 12 months of follow-up shows decreased periventricular hyperintensity

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Figure 4: MRI brain at 12 months of follow-up showing decreased temporal lobe and periventricular hyperintensity

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Syphilis is caused by Treponema pallidum and can affect the central nervous system. Late stages of neurosyphilis consist either of meningovascular or parenchymatous disease. The classic lesion of meningovascular involvement is an endarteritis obliterans causing stroke. Parenchymatous neurosyphilis includes tabes dorsalis and general paresis of insane.[1] Neurosyphilis is diagnosed with reactive serum serology with reactive CSF VDRL. Probable neurosyphilis is serologic evidence of syphilis with any one CSF abnormalities: mononuclear pleocytosis, elevated protein, increased immunoglobulin G, presence of oligoclonal bands.[2] Nearly two-third of neurosyphilis are CSF VDRL negative. TPHA was done in serum which was positive and has the same sensitivity as of Fluorescent treponemal Antibody absorption test so not done. CSF TPHA and FTA- ABS was not done due to nonavailability of test in CSF. MRI shows bilateral, discrete white matter lesions involving deep periventricular and subcortical regions with T2 hyperintensities in mesial temporal lobes along with cerebral atrophy.[3],[4],[5],[6]

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  References Top

1.
Madhusudhan M. Neurosyphillis. Neurol India 2009;57:233-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Davis LE, Schmitt JW. Clinical significance of cerebrospinal fluid test for neurosyphillis. Ann Neurol 1989;25:50-5.  Back to cited text no. 2
    
3.
Harris DE, Enterline DS, Tien RD. Neurosyphilis in patients with AIDS. Neuroimaging Clin N Am 1997;7:215-21.  Back to cited text no. 3
    
4.
Chen CW, Chiang HC, Chen PL, Hsieh PF, Lee YC, Chang MH. General paresis with reversible mesial temporal T2-weighted hyperintensity on magnetic resonance image: A case report. Acta Neurol Taiwan 2005;14:208-12.  Back to cited text no. 4
    
5.
Santos V. Differential diagnosis of nesiotemporal lesions: Case report and MRI findings. Neuroradiology 2005;47:664-7.  Back to cited text no. 5
    
6.
Lessig S, Tecoma E. Perils of the prozone reaction: Neurosyphilis presenting as an RPR-negative subacute dementia. Neurology 2006;66:777.  Back to cited text no. 6
    


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