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Neuroimaging findings in neurosyphilis
Halim Fadil1, Eduardo Gonzalez-Toledo, Bradford J Kelley
1Department of Neurology, LSU Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA.
Summary
Neurosyphilis can mimic other neurological conditions, presenting with unusual symptoms and brain scan results. This great imitator challenges diagnosis by resembling diseases like herpes simplex encephalitis or normal pressure hydrocephalus.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Neurosyphilis, caused by *Treponema pallidum*, is a complex infection affecting the central nervous system.
- Early diagnosis and treatment are crucial to prevent irreversible neurological damage.
Observation:
- Two cases of neurosyphilis with atypical clinical and neuroimaging presentations are detailed.
- Case 1: MRI findings mimicked mesial temporal sclerosis or herpes simplex encephalitis.
- Case 2: Clinical presentation suggested normal pressure hydrocephalus with MRI showing ventricular enlargement and white matter changes.
Findings:
- Neurosyphilis can present with diverse and atypical neurological symptoms.
- Neuroimaging findings in neurosyphilis can mimic various other neurological disorders, complicating diagnosis.
- Misdiagnosis led to unnecessary procedures, such as ventriculo-peritoneal shunting, before identifying active syphilitic infection.
Implications:
- Highlights the diagnostic challenges posed by neurosyphilis, emphasizing the need for a high index of suspicion.
- Underscores the importance of considering neurosyphilis in differential diagnoses, even with atypical presentations.
- Suggests that advanced neuroimaging may require careful interpretation in the context of potential syphilitic infections.
