1/171. Cerebral gumma showing spontaneous regression on magnetic resonance imaging study--case report. A 75-year-old male presented with the complaint of headache. Magnetic resonance (MR) imaging demonstrated a low-signal intensity area on both T1- and T2-weighted images with ring-like enhancement and adhesion of the dura appearing as dural tail sign. Follow-up MR imaging demonstrated spontaneous regression, so the preoperative diagnosis was malignant lymphoma. Histological examination revealed typical granuloma. treponema pallidum hemagglutination assay tests of serum and cerebrospinal fluid were positive for active syphilis. The enhanced mass totally disappeared after 4 months of erythromycin therapy. The final diagnosis was cerebral gumma. The incidence of syphilis is increasing, so cerebral gumma should be included in the differential diagnosis of hypovascular tumors that involve both the parenchyma and dura even in the presence of spontaneous regression. ( info) |
2/171. Intractable epilepsy as the initial manifestation of neurosyphilis. A 29-year-old man experienced intractable partial seizures as the initial manifestation of neurosyphilis. The diagnosis was made after the onset of dementia 9 months later. Both the epilepsy and dementia resolved with penicillin therapy. Syphilis should be considered in patients with adult-onset focal epilepsy, particularly if there is associated dementia. Treatment may be successful even when the diagnosis is delayed. ( info) |
3/171. Efficacy of corticosteroid therapy on cerebral gummas: risks and implications. Complete resolution of a cerebral gumma can take place after massive corticosteroid treatment. Such a result in patients not known as syphilitic can be misleading and hamper the identification of the true nature of the lesion. ( info) |
4/171. Not so slowly progressive visual loss. A 51-year-old man presented with bilateral progressive visual loss during a 2-month period. visual acuity was 20/60 in both eyes with bilateral constricted visual fields. Funduscopy revealed bilateral disk pallor and arteriolar attenuation. His vision declined rapidly during the next 2 weeks. Investigations showed a positive cerebrospinal fluid Venereal disease research Laboratory test (1:8). A diagnosis of neurosyphilis was made, and treatment was started with high-dose intravenous and intramuscular penicillin. ( info) |
5/171. Treatment of latent and tertiary syphilis. Although the efficacy of penicillin treatment for syphilis has been amply demonstrated, the optimal, curative dosage is still undefined. Some patients experience a third stage of the disease long after secondary-stage symptoms have resolved. Treatment differs in early and late latency and with the specific manifestations of tertiary-stage disease. ( info) |
6/171. Nonconvulsive status epilepticus resulting from Jarisch-Herxheimer reaction in a patient with neurosyphilis. We report a case of Jarisch-Herxheimer reaction in a patient with neurosyphilis, which was complicated by nonconvulsive status epilepticus. The EEG features suggested a focal seizure onset, although the patient's MRI was normal. JHR is common in the treatment of neurosyphilis, but usually produces only transient systemic constitutional symptoms. Neurologic deterioration is rare, but can be dramatic, as in our patient. NCSE should be considered as an explanation for persistent obtundation and transient focal neurologic findings in this setting. ( info) |
7/171. Contrast enhancement of the cerebrospinal fluid on MRI in two cases of spirochaetal meningitis. We report two patients with meningitis due to spirochaetal infection, both of whom showed diffusely enhancing meninges around the brain and spinal cord. In addition, there was enhancement of the cerebrospinal fluid after intravenous administration of Gd-DTPA. ( info) |
8/171. Pachymeningitis luetica: a case report. Pachymeningitis luetica is extremely rare in developed countries. We describe a 41-year-old male patient with pachymeningitis luetica, multiple ischaemic infarctions, and severe hydrocephalus. The delay in making the diagnosis contributed to patient's death. Rapid diagnosis is essential on the slightest suspicion of an infection by treponema pallidum, because timely treatment with antibiotics is effective. ( info) |
| The prevalence of syphilis increased for several decades before the mid-1990s in the united states, particularly in the southern states. We report a case of neurosyphilis causing bilateral facial and vestibulocochlear nerve dysfunction in which the diagnosis was not initially suspected based on the patient's demographics and history. The MR imaging features helped to make the diagnosis in this case and to exclude other possible causes of multiple cranial nerve dysfunction in this patient. hearing loss associated with neurosyphilis is one of the few treatable forms of progressive hearing loss, and it is essential that a diagnosis of neurosyphilis be made expeditiously. ( info) |
10/171. Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. OBJECTIVE: To determine the relative frequencies of signs in posterior segment ocular syphilis, the response to a neurosyphilis regimen of penicillin, and differences in findings between human immunodeficiency virus (hiv)-coinfected and -noncoinfected patients in a community setting. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: Fourteen consecutive patients with posterior segment ocular syphilis over a 14-year period within or during the acquired immune deficiency syndrome era. INTERVENTION: neurosyphilis intravenous penicillin regimen. MAIN OUTCOME MEASURES: Initial and final visual acuity; treponemal and nontreponemal serologic analyses; cerebrospinal fluid cell count, protein, and Venereal disease research Laboratory analyses; posterior segment signs; and relapses and recurrences. RESULTS: Blacks and males were predominantly affected. Five (36%) of patients were hiv coinfected, and ocular syphilis led to the hiv infection diagnosis in three. Four (29%) patients had received previous antibiotic therapy for primary or secondary syphilis, raising the suspicion of relapse. Two patients had negative nontreponemal serologic results. All patients responded rapidly to neurosyphilis therapy. One patient subsequently relapsed after neurosyphilis therapy, and a second was reinfected with recurrence of ocular involvement. One previously undescribed retinal manifestation was discovered: a sectorial retinochoroiditis with delayed retinal circulation in the involved area. CONCLUSIONS: Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection. Conventional syphilis staging is of little use in understanding ocular syphilis. A high suspicion for this diagnosis is appropriate, especially in poorer black males with posterior segment inflammatory disease. Human immunodeficiency virus coinfection with ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term. awareness of the multiple presentations of posterior segment ocular syphilis will aid ophthalmologists in averting misdiagnosis or delayed diagnosis. ( info) |