[Autopsy case of meningovascular neurosyphilis associated with Fischer's plaques]

We here report an autopsy case of meningovascular neurosyphilis associated with Fischer's plaques, a demyelinating lesion which is typical of the late stage general paresis. A Japanese male who was 59 years old at the time of death, developed personality change and dementia. He was clinically diagnosed as having neurosyphilis by serological tests of the blood and the cerebrospinal fluid. Despite the administration of Penicillin, psychiatric symptoms were unchanged and the patient died of aspiration pneumonia after the clinical course of 18 month. The weight of brain was 1485 g. Postmortem pathological examination of the brain revealed extensive leukocyte infiltration into the meninges, in particular, around the meningeal vessels. Perivascular leukocyte infiltration, though less severe, was also noted in the brain parenchyma in the temporal and frontal cortices. Brain atrophy and neuronal cell loss were absent. The primary pathology of this case was, thus, considered to be meningeal and vascular inflammation consistent with the stage III meningovascular neurosyphilis. However, we also found in the frontal and parietal cortices a few small demyelinating lesions, which were referred to as Fischer's plaques. Fischer's plaque is a hallmark of advanced stage of general paresis where the principal lesion exists in the brain parenchyma. We speculate that, in patients with chronic progressive neurosyphilis, meningovascular and parenchymal lesions coexist during the transitional stage. Attention has to be paid for the occurrence of atypical neurosyphilis in association with increased immuologically compromised hosts and frequent usage of antibiotics.