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

Neuroimage - Neurosyphillis

Arvind Vyas, Amit K Bagaria, Divya Goel, Vaibhav Mathur 
 Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India

Correspondence Address:
Amit K Bagaria
Room No. F-26, Resident Doctor's Hostel, SMS Medical College, Jaipur - 302 004, Rajasthan

How to cite this article:
Vyas A, Bagaria AK, Goel D, Mathur V. Neuroimage - Neurosyphillis.Neurol India 2021;69:1131-1132

How to cite this URL:
Vyas A, Bagaria AK, Goel D, Mathur V. Neuroimage - Neurosyphillis. Neurol India [serial online] 2021 [cited 2021 Dec 5 ];69:1131-1132
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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}{Figure 2}{Figure 3}{Figure 4}

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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