Neurosyphilis versus Herpes Encephalitis in a Patient with Confusion, Memory Loss, and T2-Weighted Mesiotemporal Hyperintensity

Vedes, Elisa; Geraldo, Ana Filipa; Rodrigues, Rita; Reimão, Sofia; Ribeiro, Alice; Antúnes, Francisco

doi:10.1155/2012/154863

Cited by 9 publications

(11 citation statements)

References 8 publications

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“…The most common presentation is due to meningovascular involvement. However, mesiotemporal T2-weighted hyperintensity in an asymmetrical pattern in neurosyphilis has been reported (Lauria et al, 2001;Vedes et al, 2012). This finding is a known mimicker of herpes encephalitis on neuroimaging, thus neuro- syphilis has to be included in the differential diagnosis of patients suspected of HSE (Szilak et al, 2001;Bash et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

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Neurosyphilis and psychosis

Wahab

Rani

2013

Asia-Pacific Psychiatry

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Neurosyphilis may presents with a range of psychiatric symptoms. This report illustrates a case of neurosyphilis in a man who presented with psychosis and cognitive dysfunction. Clinical findings and investigations done in the present case showed positive results for syphilis. Reduction of symptoms was noted after treatment with antibiotic. This case further highlights the importance of having high index of suspicion for neurosyphilis in patients presenting with psychiatric symptoms.

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Section: Discussionmentioning

confidence: 99%

“…This is not surprising as there may be a time lag in improvement of imaging findings. Reported time ranges in the resolution of imaging findings are wide, ranging from weeks to months (Vedes et al, 2012;Bash et al, 2001). Further follow-up MRI imaging in this patient would be helpful in assessing the progress or resolution of the findings.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis and psychosis

Wahab

Rani

2013

Asia-Pacific Psychiatry

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“…Since neurosyphilis can mimic common neuropsychiatric syndromes and because of increased risk of infection in psychiatric populations, patients with clinically evident psychiatric symptoms should have blood screening for syphilis and, in the case of a positive result, a lumbar puncture should be performed. 16 It is accepted that the diagnosis is confirmed by a positive CSF VDRL associated with consistent clinical evidence. 17 The usual clinical pattern of neurosyphilis, in people with undiagnosed syphilis, seems to be altered by inadvertently receiving incomplete treatment while taking antibiotics for other conditions.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

Toffanin

Miola

Follador

et al. 2019

Journal of Psychiatric Practice

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Limbic encephalitis is an inflammatory process of the limbic structures, with polymorphic clinical features, caused by paraneoplastic and nonparaneoplastic conditions and infections. We describe a case of neurosyphilis limbic encephalitis, presenting with reversible Geschwind syndrome (hyperreligiosity and hypergraphia) and mood disorder due to the predominant involvement of left mesial temporal structures in a previously healthy 34-year-old, left-handed woman. Because neurosyphilis can mimic common neuropsychiatric syndromes, it should be included in the differential diagnosis of psychiatric disorders with suspected general medical causes. This case of nondominant limbic encephalopathy caused by syphilis infection highlights the relevance of a careful investigation for secondary psychotic, mood, and personality disorders when assessing new-onset psychiatric illness and the importance of a multidisciplinary approach to provide a better outcome in patients with neurosyphilis.

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“…Mesial temporal sclerosis, gliomatosis cerebri, and MELAS should be included in differential diagnosis, when bilateral temporal lobe involvement is detected on MRI scan [ 19 ]. Paraneoplastic limbic encephalopathy, Hurst's disease, SLE, primary CNS lymphoma, complex partial status epilepticus, and neurosyphilis should also be included [ 20 ]. Temporal lobe involvement was unilateral in both of our patients.…”

Section: Discussionmentioning

confidence: 99%

HSV-1 Encephalitis: High Index of Clinical Suspicion, Prompt Diagnosis, and Early Therapeutic Intervention Are the Triptych of Success—Report of Two Cases and Comprehensive Review of the Literature

Patoulias

Gavriiloglou

Kontotasios

et al. 2017

Case Reports in Medicine

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Herpes Simplex Virus (HSV) encephalitis is an acute infectious disease of the Central Nervous System (CNS), usually affecting the limbic structures, the median temporal cortex, and the orbitofrontal regions. Its annual incidence has significantly increased over the last 20 years and the mortality rate is 7%, if early diagnosed and treated, and 70%, if left untreated, while it is associated with high rates of morbidity. It should be noted that even when Cerebrospinal fluid (CSF) analysis seems normal, imaging studies are not specific and HSV Polymerase Chain Reaction (PCR) test is negative; the clinician should be more aggressive, if clinical presentation is indicative for HSV encephalitis, by administrating acyclovir early after patient's admission. The latter may be a vital intervention for the patient, modifying the patient's clinical course. Through the presentation of two cases of HSV-1 encephalitis that we managed in our department over the last 1 year and after systematic and comprehensive research of the relevant literature, we aim at showing the crucial role of medical history and physical examination, along with the high index of clinical suspicion, in order to make promptly the diagnosis and administer timely intravenous acyclovir, limiting the possibility of complications during the disease's course.

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Neurosyphilis versus Herpes Encephalitis in a Patient with Confusion, Memory Loss, and T2-Weighted Mesiotemporal Hyperintensity

Cited by 9 publications

References 8 publications

Neurosyphilis and psychosis

Neurosyphilis and psychosis

A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

HSV-1 Encephalitis: High Index of Clinical Suspicion, Prompt Diagnosis, and Early Therapeutic Intervention Are the Triptych of Success—Report of Two Cases and Comprehensive Review of the Literature

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