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Published on: April 14, 2014
Neurosyphilis with unilateral optic tract lesion causing homonymous hemianopia
Kohnosuke Iwamoto1, Joe Aoyagi, Tetsuhito Kiyozuka
1Department of Neurology, Toho University Medical Center Omori Hospital, Tokyo, Japan.
The Neurologist
|November 11, 2009
Summary
A rare case of syphilis causing homonymous hemianopia is presented. Prompt penicillin treatment resolved the vision loss, highlighting neurosyphilis as a key diagnosis for optic tract lesions.
Area of Science:
- Neuro-ophthalmology
- Infectious Diseases
Background:
- Homonymous hemianopia is a common visual field defect with numerous potential causes.
- Unilateral optic tract lesions are less frequent, and syphilis is an uncommon etiology.
Observation:
- A 56-year-old woman presented with right homonymous hemianopia and bilateral tonic pupils.
- MRI revealed a lesion in the left postchiasmal optic tract with characteristic enhancement patterns.
- Positive serological and cerebrospinal fluid tests confirmed active syphilis.
Findings:
- The patient's symptoms resolved completely following benzylpenicillin treatment.
- Cerebrospinal fluid analysis showed significant pleocytosis and elevated protein levels.
- The lesion's appearance and location were consistent with neurosyphilis.
Implications:
- Neurosyphilis must be considered in the differential diagnosis of isolated optic tract lesions.
- Early diagnosis and treatment of neurosyphilis can lead to complete visual recovery.
- This case underscores the importance of considering infectious etiologies in neurological presentations.
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