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[Autopsy case of Lissauer's general paresis with rapidly progressive left hemiparesis]
Hiroko Kato1, Mari Yoshida, Tetsuo Ando
1Department of Neurology, Anjo Kosei Hospital.
Abstract:
A 48-years-old man presented with slowly progressive bradykinesia, personality change and rapidly progressive left hemiparesis. On admission, he presented dementia, poor judgment, left hemiparesis. MRI revealed a widespread high intensity area in right hemisphere and MRA was almost normal. Serological tests of serum and CSF demonstrated high titers of antibodies to Treponema pallidum. He was treated for syphilis with daily penicillin injections without improvement. He died of sepsis eight months after admission. At autopsy, the brain weighed 1,100 g and the right cerebral hemisphere was atrophic, especially in frontal base, temporal, parietal, angular, and posterior regions covered by thickened, fibrotic leptomeninges. Microscopically, chronic meningoencephalitis was observed. Severe neuronal loss with gliosis was seen in the right cerebral cortices. Scattered rod-shaped microglia and inflammatory cell infiltration were visible in the cerebral parenchyma. The dorsal column of the spinal cord was not involved and meningovascular syphilis was unclear. The distribution of the encephalitic lesions was well correlated with the clinical and neuroradiological findings. This was a rare autopsy case presenting Lissauer's general paresis, clinically manifesting as rapidly progressive stroke-like episode.
Insights
This case study describes a rare autopsy finding of Lissauer's general paresis, a form of syphilis affecting the brain. The patient experienced stroke-like symptoms and dementia, highlighting a severe neurological manifestation of syphilis.
Area of Science:
- Neurology
- Pathology
- Infectious Diseases
Background:
- Syphilis can present with diverse neurological manifestations.
- Lissauer's general paresis is a rare, severe form of neurosyphilis.
- Early diagnosis and treatment are crucial for syphilitic neurological disorders.
Observation:
- A 48-year-old man exhibited progressive bradykinesia, personality changes, and left hemiparesis, indicative of a stroke-like episode.
- Neuroimaging revealed significant abnormalities in the right cerebral hemisphere.
- Serological tests confirmed high antibody titers to Treponema pallidum in serum and cerebrospinal fluid (CSF).
Findings:
- Autopsy revealed right cerebral hemisphere atrophy with thickened leptomeninges and chronic meningoencephalitis.
- Microscopic examination showed severe neuronal loss, gliosis, and inflammatory cell infiltration in the cerebral parenchyma.
- The observed lesions correlated with clinical and radiological findings, consistent with Lissauer's general paresis.
Implications:
- This case underscores the importance of considering neurosyphilis in the differential diagnosis of rapidly progressive neurological deficits, even with atypical presentations.
- The autopsy findings provide valuable insights into the neuropathology of this rare syphilitic encephalitic form.
- Effective management strategies for neurosyphilis require a comprehensive understanding of its varied clinical and pathological spectrum.
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