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Neurosyphilis versus Herpes Encephalitis in a Patient with Confusion, Memory Loss, and T2-Weighted Mesiotemporal

Elisa Vedes1, Ana Filipa Geraldo, Rita Rodrigues

  • 1Internal Medicine Department, Centro Hospitalar Lisboa Norte, EPE, 1649-035 Lisbon, Portugal.

Case Reports in Infectious Diseases
|May 9, 2012
PubMed

Insights

Neurosyphilis can mimic herpes encephalitis, presenting with confusion and memory loss. This highlights the importance of considering neurosyphilis in differential diagnoses for these neurological symptoms.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Herpes simplex encephalitis (HSE) is typically characterized by acute confusion, memory loss, and specific MRI findings like asymmetrical mesiotemporal hyperintensity on T2-weighted images.
  • Neurosyphilis, a complex neurological manifestation of syphilis infection, is experiencing a resurgence.
  • The diagnostic challenge lies in differentiating neurosyphilis from other neurological conditions with similar presentations.

Observation:

  • The authors present a case study of a patient exhibiting symptoms and MRI findings classically associated with herpes encephalitis.
  • Despite the typical presentation of herpes encephalitis, the patient was diagnosed with neurosyphilis.
  • This case underscores the evolving clinical and imaging patterns observed in neurosyphilis.

Findings:

  • Neurosyphilis can present with clinical and radiological features that closely mimic herpes simplex encephalitis.
  • T2-weighted MRI may show asymmetrical mesiotemporal hyperintensity in neurosyphilis, a pattern previously considered pathognomonic for HSE.
  • The "Great Pretender" moniker for syphilis extends to its ability to imitate other neurological diseases on imaging.

Implications:

  • Neurosyphilis should be actively considered in the differential diagnosis for patients presenting with acute confusion, memory loss, and MRI findings suggestive of herpes encephalitis.
  • Increased vigilance and diagnostic testing for syphilis are warranted given the rising incidence of the disease.
  • Accurate and timely diagnosis of neurosyphilis is crucial to prevent irreversible neurological damage and ensure appropriate treatment.

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