[Neurosyphilis presenting the left total ophthalmoplegia: a case report]

We report a 73-year-old woman with meningitis-type neurosyphilis presenting the main symptom of the left total ophthalmoplegia. Three months after the appearance of the deviation of the eyeball to the inside and ptosis of the left eyelid, the left eyelid was completely closed. On admission, about four months after the appearance of neurosyphilis, she showed paralysis of the left oculomotor nerve, trochlearis nerve and abducens nerve, and the right mydriasis and absent light reflex. She was diagnosed as meningovascular neurosyphilis because syphilitic antibodies reactions in both serum and cerebrospinal fluid were highly positive. We treated her with intravenous infusion drop of penicillin G (eighteen-million units/day) for ten days, and those symptoms mentioned above other than light reflex were completely recovered. Bilateral internal carotid arteries situated close each other at the supraclinoid portion. The internal carotid arteries were not enhanced on Gd-MRI and the stenosis of the arteries were not detected on MRA. However, we suppose that the inflammation of meninges at that portion spreads to the bilateral internal carotid arteries, and that the III, IV and VI nerves close to the left internal carotid artery were damaged. There have been no reports of meningovascular neurosyphilis with the manifestation of unilateral ophthalmoplegia. In the patients of meningovascular neurosyphilis, however, various cranial nerve palsies can be appeared. Therefore we suggest that neurosyphilis should always be taken into consideration as differential diagnosis of cranial nerve palsies.