Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital

Nagappa, Madhu; Sinha, Sanjib; Taly, Arun B.; Rao, Shilpa; Nagarathna, S; Bindu, Parayil Sankaran; Bharath, Rose Dawn; Murthy, Pratima

doi:10.1007/s00234-012-1017-9

Cited by 74 publications

(45 citation statements)

References 18 publications

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“…3,4 In our patient, posterior spinal ischemia resembling acute-onset tabes dorsalis could have been caused by syphilitic posterior spinal arteritis or by occlusion of a spinal artery related to thoracic aortitis.…”

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confidence: 70%

Posterior spinal cord infarctions due to neurosyphilis

2014

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A n 86-year-old patient with multiple vascular risk factors including 3 previous strokes woke up with a sensation of wet lower limbs, with bilateral loss of proprioception in legs on examination. Cervical MRI showed 2 acute medullary ischemic lesions in the posterior columns at level C3 and C4 (figure 1, A-D). Biological screening including HIV serology, Treponema pallidum hemagglutination assay (TPHA), Venereal Disease Research Laboratory test (VDRL), and Lyme disease serology showed an increased TPHA titer of 1:320, with a negative VDRL.Lumbar puncture (LP) revealed 6 leukocytes/mm 3 and elevated proteins (736 mg/L). The modified TPHA index (mTPHAi) 1 was 1.06 (.2 positivity, ,0.8 negativity). A repeat LP 3 months later showed 1 leukocyte/mm 3 , 539 mg/L, and an mTPHAi of 3.1. Cervical MRI showed 2 acute medullary ischemic lesions in the posterior columns at level C3 and C4 ( figure 1, A-D). An aortic CT showed aortic arteritis, with thickened, contrast-enhancing wall ( figure 2, A and B). The patient recalled a positive syphilitic serology at age 30, treated with IM antibiotherapy of unknown dose and duration.Neurosyphilis was thus considered and the patient was treated with ceftriaxone 2 g IV/d 3 14 days.2 Meningovascular syphilis can present as meningovasculitis, transverse myelitis, or spinal artery syndromes.3,4 In our patient, posterior spinal ischemia resembling acute-onset tabes dorsalis could have been caused by syphilitic posterior spinal arteritis or by occlusion of a spinal artery related to thoracic aortitis. STUDY FUNDINGNo targeted funding reported.

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confidence: 70%

Posterior spinal cord infarctions due to neurosyphilis

2014

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“…The signs and symptoms of neurosyphilis are protean, and the US Centers for Disease Control and Prevention (CDC) has provided general criteria for classification based on the dominant characteristics of the patient which include neuropathic, meningovascular, and myelopathic symptoms. However, these criteria are too broad to provide an effective guide for diagnosis, and require clinical judgment to reduce diagnostic omissions [22, 23]. In addition, there are several overlaps between the symptoms [24].…”

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confidence: 99%

Early neurosyphilis presenting with facial palsy and an oral ulcer in a patient who is human immunodeficiency virus positive: a case report

et al. 2017

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BackgroundNeurosyphilis is the tertiary stage of Treponema pallidum infection that involves the central nervous system, which occurs within days or weeks after an initial syphilis infection, especially in immunocompromised patients. The diagnosis of neurosyphilis is quite challenging as it is uncommon and often presents with obscure symptoms since any organ system may be involved.Case presentationWe describe a case of a 40-year-old African man who is human immunodeficiency virus positive with early neurosyphilis who presented with a stiff neck, headache, confusion, restlessness, and a left-sided chest pain; he did not respond to an empiric treatment of ceftriaxone and fluconazole for meningitis, and tramadol for headache. Ten days after admission, he developed generalized tonic–clonic convulsions; on examination he had ipsilateral facial nerve palsy and an oral ulcer, and responded well to benzathine penicillin treatment.ConclusionsLaboratory diagnosis of neurosyphilis is challenging because to date there is no single laboratory test which is considered sensitive enough for diagnosis of the disease, especially in resource-limited settings. Clinical judgment is still an important part of diagnosis; and neurosyphilis should be considered a diagnostic differential in patients with Human Immunodeficiency Virus presenting with central nervous system involvement and in other high-risk patients.

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“…These are neuropsychiatric, meningovascular, and myelopathic (9). Six such diagnostic categories, as derived, could be outlined as follows: neuropsychiatric disorders, cerebrovascular accident, ocular, myelopathy, seizure, and brain stem/cranial nerves.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis, One Rarely Seen Cause of Neurogenic Bladder

Bayar¹,

Çakmak²,

Gumus³

et al. 2014

JAREM

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With the exploration of penicillin, incidents of syphilis, which swept the Europe during the 16th century, decreased after 1940. Neurogen bladder arising from neurosyphilis was seen frequently before the penicillin period. We aimed to share a patient who has this rarely seen association. A 46-year-old male patient was admitted to a neurology clinic because of convulsion, dementia, and incontinence. No lesion determined in brain at magnetic resonance study. In the cerebrospinal fluid investigation, an increase in the number of leukocytes with lymphocytes and amount of protein was determined. Based on high positive treponema palladium hemagglutination assay (TPHA) test in the cerebrospinal fluid and blood, the presence of suspect sexual intercourse history, and occurrence of eruption on hands and feet that cleared up 10 years ago, a neurosyphilis diagnosis was made, and 6x4 M IU/d units iv penicillin treatment was applied for 21 days. After the completion of the patient's treatment in the neurology clinic, further examination was decided, because it was thought that neurogen bladder arising from neurosyphilis might develop because of the presence of urinary incontinence and pollakiuria complaints. At the beginning, uroflowmetry was worked to be done; however, the patient could not make enough (at least 150 mL) micturation. Thereupon, we decided to do filling cystometry and pressure-flow study. It was seen in the ultrasonography that bladder volume was 500 mL, thickness of the bladder wall was at normal level, prostate volume was 20 cc, and kidneys were bilaterally normal. It was seen that residual urine was approximately 400 cc after micturition. In filling cystometry, it was seen that maximum bladder capacity before the overflow incontinence was 490 mL. It was seen that the first urinary feeling occurred at 350 mL of volume and 26 cm H 2 O of pressure; first urge to void feeling occurred at 460 mL volume and 35 cm pressure. It was seen that sense of bladder started to get damaged; however, the sense was not completely gone yet. It was seen that intra-vesicular pressure increased at 300 mL of volume and was more than 40 cm H 2 O of pressure at end of study. It was decided that the bladder compliance was 12.4 mL/cm H 2 O and that there was a medium-level loss of compliance. It was seen at the pressure-flow study that the patient who was encouraged to micturate for 2 minutes could only micturate by increasing intra-abdominal pressure, and detrusor pressure did not increase. As is, a hyposensitive and acontractile bladder diagnosis was made. It was thought that aseptic intermittent catheterization (AIC) and oral anticholinergic treatment were appropriate for the patient. Neurosyphilis is a rarely seen disease nowadays. Neurogen bladder arising from neurosyphilis is much rare in urology practices. When encountering a patient with this disease, urodynamic assessment should be done in order to have an idea about bladder functions; a choice should be made among bladder neck resection, urinary diversion and AIC. (...

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Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital

Abstract: 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.

Cited by 74 publications

References 18 publications

Posterior spinal cord infarctions due to neurosyphilis

Posterior spinal cord infarctions due to neurosyphilis

Early neurosyphilis presenting with facial palsy and an oral ulcer in a patient who is human immunodeficiency virus positive: a case report

Neurosyphilis, One Rarely Seen Cause of Neurogenic Bladder

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