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Chen B, Shi H, Hou L, Zhong X, Wang Y, Wu Z, Peng Q, Zheng D, Zhang Y, Tan Y, Fang Z, Chen X, Luo X, Liu S, Yuping N. Medial temporal lobe atrophy as a predictor of poor cognitive outcomes in general paresis. Early Interv Psychiatry 2019; 13:30-38. [PMID: 28378939 DOI: 10.1111/eip.12441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/15/2016] [Accepted: 02/05/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The effect of penicillin therapy on clinical outcomes vary among patients with general paresis (GP). We sought to explore biomarkers that might serve as predictors of clinical outcomes in GP and identify patients requiring early intervention. METHODS Thirty-five inpatients with GP were recruited. Each GP patient underwent comprehensive neuropsychological, neuroimaging and laboratory assessments before receiving penicillin therapy, and returned for follow-up evaluations after 6 months. The visual rating of medial temporal lobe atrophy (MTA) and the Fazekas scale was used to analyze the neuroimaging abnormalities. RESULTS MTA scores were correlated with the pre-treatment cognitive scores and change in Mini Mental State Examination scores. GP patients with a Clinical Dementia Rating Scale (CDR) ≤1 or MTA scores ≤2 achieved significant improvement in neuropsychological test scores, as compared with patients with CDR >1 or MTA scores >2. Fazekas scale scores correlated with the pre-treatment attention scores. Significant improvements in cognitive test scores were observed in GP patients with normalization of serum rapid plasma regain (RPR) titers, but not those without normalization of RPR titers. CONCLUSIONS Severe MTA may serve as a predictor of poor cognitive outcome and an indicator of severe cognitive impairment in GP patients. Thus, early interventions for improving cognitive function may be considered for GP patients with severe MTA. White matter hyperintensities may associated with attention impairment. Serum RPR titer may serve as a sensitive indicator of therapeutic effect in GP.
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Affiliation(s)
- Ben Chen
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital) and Southern Medical University, Guangzhou, China
| | - Haishan Shi
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Le Hou
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaomei Zhong
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yanhua Wang
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Zhangying Wu
- Department of Psychiatry, Guangzhou Medical University, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Qi Peng
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Dong Zheng
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuefen Zhang
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yan Tan
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ziyan Fang
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xinru Chen
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xinni Luo
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Sha Liu
- Department of Radiology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ning Yuping
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital) and Southern Medical University, Guangzhou, China
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Shao X, Qiang D, Liu Y, Yuan Q, Tao J, Ji B. Diagnosis and Treatment of Cerebral Syphilitic Gumma: A Report of Three Cases. Front Neurosci 2018. [PMID: 29535598 PMCID: PMC5835125 DOI: 10.3389/fnins.2018.00100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral syphilitic gumma is very rare and is often pathologically confirmed following surgery. This study reports three patients with cerebral syphilitic gumma. The first case was a 62-year-old man who was admitted to our hospital due to speech arrest for 10 hours. Head MRI showed a nodular signal shadow with a significant enhancement and a significant centerline shift. He subsequently received surgery, and cerebral syphilitic gumma was confirmed by postoperative pathology. The second patient was a 66-year-old man who was admitted to our hospital due to complaints of gradually decreasing right eye vision and headache for nearly 50 days. Enhanced MRI at admission indicated irregular clumping of high-signal mixed with low-signal foci on the frontal lobe. Subsequently, he was operatively treated and was confirmed to have cerebral syphilitic gumma by postoperative pathology. The third patient was a 37-year-old man who was admitted to our hospital due to dizziness for approximately 15 days. Head MRI indicated a slightly abnormal lamellar and longer T1, T2 signal shadow on the left side. He did not receive surgery, and his symptoms disappeared after anti-syphilitic treatment. Hence, we recommend a critical interpretation of preoperative imaging data, understanding the unique changes that arise in the brain that can be detected through imaging, and an analysis of the patient history and laboratory tests to re-evaluate the value of surgery, with the ultimate goal of performing a stabilizing treatment for cerebral syphilitic gumma.
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Affiliation(s)
- Xuefei Shao
- Department of Neurosurgery, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China
| | - Di Qiang
- Department of Dermatology and STD, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China
| | - Yinhua Liu
- Department of Neurosurgery, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China.,Department of Pathology, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China
| | - Quan Yuan
- Department of Neurosurgery, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China.,Department of Imaging, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China
| | - Jin Tao
- Department of Neurosurgery, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China
| | - Bihua Ji
- Department of Dermatology and STD, Yi-Ji Shan Hospital, Wannan Medical College, Wuhu, China
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Park J, Kwon KY. Reversible Dementia with Middle Cerebellar Peduncle Hyperintensity: 1-Year Follow-Up of HIV-Negative Neurosyphilis. J Clin Neurol 2017; 13:437-438. [PMID: 28831790 PMCID: PMC5653637 DOI: 10.3988/jcn.2017.13.4.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/06/2017] [Accepted: 05/10/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jisang Park
- Department of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, Korea
| | - Kyum Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea.
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4
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Shi F, Jiang H, Shi Z, Liu H, Zhang Q. Cerebral Syphilitic Gumma: Case Report of a Brainstem Mass Lesion and Brief Review of the Literature. Jpn J Infect Dis 2017; 70:595-596. [PMID: 28674317 DOI: 10.7883/yoken.jjid.2017.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fei Shi
- Department of Neurosurgery, Shanghai First People's Hospital, Shanghai Jiaotong University
| | - Hongyu Jiang
- Department of Anesthesia, the Third People's Hospital of Wuxi
| | - Zhonghua Shi
- Department of Neurosurgery, No. 101 Hospital of PLA
| | - Hongyu Liu
- Department of Neurosurgery, Chinese PLA General Hospital
| | - Qiuhang Zhang
- Department of Skull Base Surgery Center, Otorhinolaryngology Head and Neck surgery, Xuanwu Hospital, Capital Medical University
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5
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Clinical and laboratory characteristics in patients suffering from general paresis in the modern era. J Neurol Sci 2015; 350:79-83. [PMID: 25703276 DOI: 10.1016/j.jns.2015.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND No gold standard currently exists for the diagnosis of general paresis (GP), thus often resulting in unnecessarily delayed therapeutic decision. METHODS A retrospective chart review was performed for 85 inpatients with GP in Zhongshan Hospital, Medical College of Xiamen University, and the characteristics of their clinical profiles, serum and cerebrospinal fluid (CSF) examinations, neuroimaging examination, and electroencephalogram (EEG) data were analyzed. RESULTS Among the 85 GP patients, the clinical symptoms that were frequently observed upon admission included a variety of psychiatric-behavioral symptoms and varying degrees of cognitive impairment. All of the patients had positive serum Treponema pallidum particle agglutination (TPPA) assays, 96.47% of the patients had positive CSF TPPA assays, and 41.18% of the patients had both CSF pleocytosis and elevated CSF protein levels. Focal atrophy in one cerebral region or in multiple regions was evident in neuroimages. The EEG data primarily showed slightly abnormal EEG activity. CONCLUSION These results demonstrate the complexity of the clinical characteristics of GP and highlight the importance of early diagnosis.
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Ishihara T, Ishihara A, Ozawa T, Sanpei K, Shimohata T, Nishizawa M. [Clinical course and serial brain MRI findings in a patient with Lissauer form of general paresis]. Rinsho Shinkeigaku 2015; 55:238-242. [PMID: 25904252 DOI: 10.5692/clinicalneurol.55.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 60-year-old man presented with progressive dementia and generalized convulsions. An initial MRI revealed a widespread high-intensity area with a mass effect in the right frontal and temporal lobes on T2-weighted images. Findings on digital subtraction angiography were normal. Serum and CSF tests showed high titers of antibodies to Treponema pallidum, which helped to distinguish neurosyphilis from glioma. He was initially treated with penicillin injection; however, it caused liver dysfunction and penicillin was switched to erythromycin. Even after antibiotic therapy for 2 months, his dementia did not improve. He underwent brain MRI four times during the treatment course, and they showed steady progression of brain atrophy in the right hemisphere. Taking these findings together, we diagnosed Lissauer form of general paresis. To the best of our knowledge, this is the first case of Lissauer form of paretic neurosyphilis, in which the progression of brain atrophy was clearly demonstrated on MRI.
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Affiliation(s)
- Tomohiko Ishihara
- Department of Neurology, Brain Research Institute, Niigata University
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Abstract
We report a case of neurosyphilis with magnetic resonance imaging (MRI) brain scan findings compatible with a diagnosis of herpes simplex encephalitis with negative testing for herpes simplex virus in the cerebral spinal fluid. An extensive review of the literature has been undertaken revealing 24 cases worldwide where there are mesiotemporal changes on MRI concurrent with a diagnosis of neurosyphilis. Therefore, it is now well established that neurosyphilis, 'the great imitator', should be considered in the differential diagnosis in all patients demonstrating mesiotemporal changes on MRI, changes usually seen in herpes simplex encephalitis.
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Affiliation(s)
- R B Saunderson
- Department of Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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8
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Abstract
The objective of this study was to improve the knowledge of the clinical and MRI presentation of general paresis of the insane (GPI) and achieve its early diagnosis. Fifteen patients with GPI were gathered. Their clinical data and brain MRI information were analyzed. The age range was 33-62 years (mean: 48·8 years). The disease lasted 34 days-28 months (mean: 10·87 months). Treponema pallidum hemagglutination assays (TPHAs) on the cerebrospinal fluid (CSF) and sera were positive. All patients were human immunodeficiency virus (HIV) negative and primarily showed progressive cognitive impairment, mostly accompanied with emotional disturbance and psychosis. The accompanying symptoms included epilepsy (n = 7), ataxia (n = 5), cerebral vascular disease (n = 3), and limbs tremor (n = 2). Typical Argyll Robertson's pupil was observed in two cases. A CSF examination showed elevated white blood cell (WBC) and protein level. Purely cerebral atrophy was found in three cases. Abnormal high signals were found in nine cases in different brain area, mainly in bilateral temporal, insular, and frontal lobes and hippocampus in T2-weighted and fluid-attenuated inversion recovery (FLAIR), which was accompanied by cerebral and/or hippocampus atrophy. Purely atrophy of bilateral or unilateral hippocampus was found in two cases. Cerebral infarction lesions were found in three cases. Contrary to the previous reports, the hippocampal atrophy and bilateral abnormal signals of hippocampus and temporal lobe in brain MRI were more common in cases with GPI. Abnormal signals were probably related to proliferation of glial cells rather than cytotoxic edema. The pathogenesis of the abnormal signals needs to be further explored. General paresis of the insane has a wide variety of central nervous system manifestations, either clinically or neuroradiologically. Identification of these presentations could be important for early diagnosis.
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Khamaysi Z, Bergman R, Telman G, Goldsher D. Clinical and imaging findings in patients with neurosyphilis: a study of a cohort and review of the literature. Int J Dermatol 2013; 53:812-9. [PMID: 24261864 DOI: 10.1111/ijd.12095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most patients with neurosyphilis are considered asymptomatic. The diagnosis is challenging and the role of neuroimaging is not yet well established. The present study was conducted to focus on the clinical findings and further characterize the imaging features of the disease, along with a review of the pertinent literature. METHODS Six male patients with neurosyphilis based on abnormal cerebrospinal fluid findings, five of whom were asymptomatic at presentation, underwent cranial computerized tomography (CT) and magnetic resonance imaging (MRI). They also underwent a complete physical, neurological, and ophthalmological examination, with special attention paid to atherosclerotic vascular risk factors. In addition, all were examined for cardiac involvement using electrocardiography and cardiac ultrasound. RESULTS The meticulous neurological and ophthalmological examination revealed abnormalities in five patients, most commonly cranial nerve involvement (three patients) and hemiparesis (two patients). The CT and MRI studies revealed abnormalities in five of the six patients, and in all six patients, respectively. The most common findings were brain infarcts, which were demonstrated in four of the six patients. MRI was found to be more sensitive than CT in detecting these brain infarcts, as expected. CONCLUSIONS Vascular insult was the most common neuroimaging finding in our patients with neurosyphilis, probably due to meningovascular endarteritis. Neurosyphilis should always be considered in young patients with unexplained brain infarcts.
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Affiliation(s)
- Ziad Khamaysi
- Department of Dermatology, Rambam Health Care Campus and the Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
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10
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Abstract
Bacterial CNS infections comprise a wide spectrum of diseases, which may be acquired outside or inside the hospital, affect immunocompetent or immunocompromised patients, and be associated with trauma or procedures, as well as other exposures.
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Affiliation(s)
- Katharina M Busl
- Department of Neurological Sciences, Section of Neurocritical Care, Rush University Medical Center, 1725 West Harrison Street, POB Suite 1121, Chicago, IL, 60612, USA,
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11
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Affiliation(s)
- M-H Chen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan, ROC.
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12
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Geisler F, Smyth M, Oechtering J, Tuetuencue S, Klostermann F, Nolte CH. Auto-antibody-negative limbic-like encephalitis as the first manifestation of Neurosyphilis. Clin Neurol Neurosurg 2013; 115:1485-7. [DOI: 10.1016/j.clineuro.2012.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 11/09/2012] [Accepted: 11/18/2012] [Indexed: 11/29/2022]
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13
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Nagappa M, Sinha S, Taly AB, Rao SL, Nagarathna S, Bindu PS, Bharath RD, Murthy P. Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital. Neuroradiology 2012; 55:379-88. [PMID: 23274762 DOI: 10.1007/s00234-012-1017-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/31/2012] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The clinical and MR imaging features of neurosyphilis are highly varied. In this study, we describe the spectrum of the imaging findings in patients with neurosyphilis. METHODS The MR imaging observations of 35 patients diagnosed to have neurosyphilis on the basis of cerebrospinal fluid reactive for the Venereal Disease Research Laboratory test were reviewed. RESULTS All the 35 patients, including four with human immunodeficiency virus coinfection, met the CDC diagnostic criteria for neurosyphilis. Patients were classified into three groups: (1) neuropsychiatric, (2) meningovascular, and (3) myelopathic, based on the dominant clinical manifestations. Fourteen patients with neuropsychiatric manifestations showed diffuse cerebral atrophy (14), parenchymal signal changes in the mesial temporal region (2) and temporal and basifrontal regions (1), infarcts (3), and nonspecific white matter changes (3). Eleven patients with meningovascular form showed infarcts (6), diffuse cerebral atrophy (3), signal changes in the mesial temporal region (3), sulcal exudates (1), progressive multifocal leukoencephalopathy (1), and a mass surrounding the carotid sheath (1). Spine imaging in ten patients with myelopathy showed long-segment signal changes (5), contrast enhancement (2), and dorsal column involvement (2). Three of these patients had normal spinal study. Six patients in the myelopathic group also underwent brain MRI that showed signal changes in the temporal region (2) and frontal region (1), multiple infarcts (1), and enhancing hypothalami (1). Three patients had normal study. CONCLUSION MRI abnormalities in neurosyphilis are protean and mimic of many other neurological disorders and thus require a high index of suspicion to reduce diagnostic omissions.
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Affiliation(s)
- M Nagappa
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560 029 Karnataka, India
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Dharmasaroja PA, Dharmasaroja P. Serum and cerebrospinal fluid profiles for syphilis in Thai patients with acute ischaemic stroke. Int J STD AIDS 2012; 23:340-5. [DOI: 10.1258/ijsa.2011.011207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The diagnosis of neurosyphilis is complicated in elderly patients who have cerebrovascular risk factors and present with ischaemic stroke. We performed an analysis of serum and cerebrospinal fluid (CSF) profiles for neurosyphilis in acute stroke patients, particularly in those with atherosclerotic risk factors. In sera, the rapid plasma reagin (RPR) test and Treponema pallidum haemagglutination assay (TPHA) were used. In CSF, the RPR and fluorescent treponemal antibody-absorption tests were used together with CSF white blood cell (WBC) count and protein level. Baseline characteristics, including atherosclerotic risk factors, severity of stroke and computed tomography brain scan images were collected. Of the total 284 patients, 24 (8.4%) had TPHA-positive sera, from which 29.2% had a positive CSF for syphilis. Seven stroke patients (2.5%), with a mean age of 65.7 years, were diagnosed with symptomatic neurosyphilis, and 71% of them had atherosclerotic risk factors. Most symptomatic patients (85.7%) had CSF WBCs>20 cells/mm3, with a mean of 98.6 ± 136.0 versus 3.2 ± 7.3 in non-neurosyphilitic patients ( P = 0.0009). Less than 50% of the symptomatic patients had CSF protein levels >50 mg/dL, and the protein levels of neurosyphilitic and non-neurosyphilitic groups were not significantly different, with means of 52.0 ± 12.9 and 51.8 ± 15.9 mg/dL, respectively. There were no significant differences in age and stroke severity. Interpretation of CSF findings, particularly of CSF WBC counts and protein levels, must be appropriate to ascertain true symptomatic neurosyphilis cases and to reduce false-positive diagnoses, particularly in countries with a high prevalence of T. pallidum infection.
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Affiliation(s)
- P A Dharmasaroja
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani
| | - P Dharmasaroja
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
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Li JC, Mahta A, Kim RY, Saria M, Kesari S. Cerebral syphilitic gumma: a case report and review of the literature. Neurol Sci 2011; 33:1179-81. [PMID: 22167653 DOI: 10.1007/s10072-011-0878-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
A 45-year-old male presented with subacute onset of a right-sided hemiparesis, right homonymous hemianopsia, and slurred speech. The brain imaging revealed two separate intraparenchymal enhancing lesions. The cerebrospinal fluid rapid plasma reagin and venereal disease research laboratory test were positive and consistent with syphilitic gumma, and the patient responded dramatically to penicillin G. Despite, currently low incidence of syphilis; CNS gummas should be in the differential of mass lesions as they are eminently treatable.
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Affiliation(s)
- Jing-Cheng Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing 400042, China
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Brisset M, Chadenat ML, Cordoliani Y, Kamga-Tallom R, D’Anglejean J, Pico F. Aspect IRM de la neuropsyphillis. Rev Neurol (Paris) 2011; 167:337-42. [DOI: 10.1016/j.neurol.2010.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 06/11/2010] [Accepted: 08/27/2010] [Indexed: 11/15/2022]
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Chahine LM, Khoriaty RN, Tomford WJ, Hussain MS. The changing face of neurosyphilis. Int J Stroke 2011; 6:136-43. [PMID: 21371276 DOI: 10.1111/j.1747-4949.2010.00568.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence of syphilis has increased over the past decade, particularly among HIV-positive patients, and the presenting clinical features have changed since the beginning of the HIV epidemic. The clinical manifestations of neurosyphilis are protean, and include acute stroke. In patients with HIV, the diagnosis and treatment of neurosyphilis is challenging. We review the clinical presentation, pathophysiology, and treatment of neurosyphilis, with emphasis on neurosyphilis in the HIV population, and neurosyphilis as a cause of acute stroke.
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Affiliation(s)
- Lama M Chahine
- Division of Neurology, Cleveland Clinic, Cleveland, OH 44016, USA
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Kobayashi J, Nakagawa Y, Tobisawa S, Isozaki E, Koide R. Deterioration of MRI findings related to Jarisch-Herxheimer reaction in a patient with neurosyphilis. J Neurol 2010; 258:699-701. [PMID: 21042805 DOI: 10.1007/s00415-010-5808-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/10/2010] [Accepted: 10/18/2010] [Indexed: 11/25/2022]
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Abstract
Neurosyphilis literally means syphilitic infection of the central nervous system, but it is often referred to incorrectly as "tertiary syphilis." Neurosyphilis can occur at any time in the course of syphilis, even in the earliest, primary, stage. Early forms of neurosyphilis primarily affect the meninges, cerebrospinal fluid, and cerebral or spinal cord vasculature. Late forms of neurosyphilis primarily affect the brain and spinal cord parenchyma. Uveitis and hearing loss related to syphilis are most common in early syphilis and may be accompanied by early neurosyphilis. The treatment for syphilis-related eye disease and hearing loss is the same as the treatment for neurosyphilis. Neurosyphilis is more commonly seen in patients infected with HIV, and much of the recent literature pertains to this risk group. This article provides a critical review of recent literature on the diagnosis, clinical findings, risk factors, and management of neurosyphilis.
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Affiliation(s)
- Christina M Marra
- University of Washington School of Medicine, Harborview Medical Center, Box 359775, 325 Ninth Avenue, Seattle, WA 98104, USA.
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20
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A case of secondary syphilis presenting as optic neuritis. Neurol Sci 2010; 31:365-7. [PMID: 20182899 DOI: 10.1007/s10072-010-0222-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
Abstract
Neurosyphilis is still a significant medical problem in developing countries and syphilitic ocular manifestations are often not diagnosed due to the lack of typical characteristics. We describe the case of a 59-year-old homosexual man with a 1-month history of decreased vision acuity in his left eye who was diagnosed with neurosyphilis and received treatment with intravenous penicillin G (16 million units in divided daily doses), with great improvement of visual acuity and CSF examination findings. The interest of this case is not only represented by the unusually early ocular involvement, but also by the rapid evolution of the disease into the secondary stage in a man who had had one at-risk homosexual relationship only 3 months before the onset symptoms. We also support the view that the presence of ocular involvement in syphilitic patients is suggestive of involvement of the CNS and should be considered synonymous with neurosyphilis.
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Clinical presentation and imaging of general paresis due to neurosyphilis in patients negative for human immunodeficiency virus. J Clin Neurosci 2010; 17:308-10. [PMID: 20080408 DOI: 10.1016/j.jocn.2009.07.092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 06/11/2009] [Accepted: 07/06/2009] [Indexed: 11/24/2022]
Abstract
The clinical presentations and MRI of six patients with general paresis due to neurosyphilis were reviewed. Diagnosis was based on neurological and psychiatric symptoms, positive Treponema pallidum hemagglutination in cerebrospinal fluid (CSF) and sera, and serology that was negative for human immunodeficiency virus by enzyme-linked immunosorbent assay. Most patients had lymphocytic, monocytic pleocytosis and high protein levels in their CSF. One patient had periodic lateral epileptiform discharges, one patient had epileptiform discharges and three patients had slowing of background activity on electroencephalography. Two patients had hyperintense signal abnormalities in the anterior and mesial temporal lobe, while four patients were found by MRI to have cerebral atrophy. Three patients developed white matter lesions. Therefore, clinical, electroencephalography and MRI findings are valuable in the diagnosis of general paresis of neurosyphilis.
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Kato H, Yoshida M, Ando T, Sugiura M, Hashizume Y. [Autopsy case of Lissauer's general paresis with rapidly progressive left hemiparesis]. Rinsho Shinkeigaku 2009; 49:348-53. [PMID: 19618844 DOI: 10.5692/clinicalneurol.49.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 48-years-old man presented with slowly progressive bradykinesia, personality change and rapidly progressive left hemiparesis. On admission, he presented dementia, poor judgment, left hemiparesis. MRI revealed a widespread high intensity area in right hemisphere and MRA was almost normal. Serological tests of serum and CSF demonstrated high titers of antibodies to Treponema pallidum. He was treated for syphilis with daily penicillin injections without improvement. He died of sepsis eight months after admission. At autopsy, the brain weighed 1,100 g and the right cerebral hemisphere was atrophic, especially in frontal base, temporal, parietal, angular, and posterior regions covered by thickened, fibrotic leptomeninges. Microscopically, chronic meningoencephalitis was observed. Severe neuronal loss with gliosis was seen in the right cerebral cortices. Scattered rod-shaped microglia and inflammatory cell infiltration were visible in the cerebral parenchyma. The dorsal column of the spinal cord was not involved and meningovascular syphilis was unclear. The distribution of the encephalitic lesions was well correlated with the clinical and neuroradiological findings. This was a rare autopsy case presenting Lissauer's general paresis, clinically manifesting as rapidly progressive stroke-like episode.
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Affiliation(s)
- Hiroko Kato
- Department of Neurology, Anjo Kosei Hospital
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Zhang SQ, Wan B, Ma XL, Zheng HM. Worsened MRI findings during the early period of treatment with penicillin in a patient with general paresis. J Neuroimaging 2008; 18:360-3. [PMID: 18302644 DOI: 10.1111/j.1552-6569.2007.00199.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 52-year-old man was diagnosed with general paresis, whose HIV antibodies were negative. After initiation of treatment with penicillin on the first day, no obvious clinical Jarisch-Herxheimer reaction was found. However, 6 days after treatment, the patient was found more irritable and was unable to fall asleep at night. On the seventh day, worsened magnetic resonance imaging (MRI) abnormalities in the bilateral medial and anterior temporal lobes were unexpectedly discovered. These worsened MRI abnormalities improved quickly after the addition of dexamethasone treatment. We consider that these transient and slight mental symptoms may be associated with the transiently worsening phenomenon in cerebral MRI findings during the early period of treatment with penicillin. This indicates that some nonspecific inflammatory process has happened in the early stage of treatment, which necessitates the use of corticosteroids after the occurrence of systemic or mental symptoms.
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Affiliation(s)
- She-Qing Zhang
- Department of Neurology, Changhai Hospital, Shanghai, China.
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van Eijsden P, Veldink JH, Linn FH, Scheltens P, Biessels GJ. Progressive dementia and mesiotemporal atrophy on brain MRI: neurosyphilis mimicking pre-senile Alzheimer's disease? Eur J Neurol 2007; 15:e14-5. [PMID: 18093152 DOI: 10.1111/j.1468-1331.2007.02018.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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