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[A case of neurosyphilis presenting as bilateral temporal, cortical and subcortical encephalitis]
Yuji Nishi1, Toshiyuki Hayashi1, Akihito Kutsuna1
1Department of Neurology, Nippon Medical School Graduate School of Medicine.
Abstract:
A 37-year-old man who had a low grade fever for 5 days admitted to our hospital due to disturbance of consciousness and seizure. Brain MRI showed abnormal hyperintensity in the bilateral temporal lobes, cortical and subcortical lesions on fluid-attenuated inversion recovery image. Treponemal and non-treponemal specific antibodies were positive in serum and cerebrospinal fluid, therefore he was diagnosed as having neurosyphilis. Treatment with intravenous penicillin G and metylpredonisolone improved his clinical symptons, imaging abnormalities and CSF findings. Patients of neurosyphilis with mesiotemporal encephalitis show common features such as young age, HIV-negative, subacute cognitive impairment and seizure, as seen in our case. Early diagnosis of neurosyphilis and appropriate treatment make clinical improvement, however the clinical diagnosis of neurosyphilis is sometime difficult because most patients present with disturbance of consciousness or seizure. The possibility of neurosyphilis should be considered when MRI results indicate temporal abnormalities.
Insights
Neurosyphilis can cause severe neurological symptoms like seizures and altered consciousness. Early diagnosis and treatment with penicillin G are crucial for recovery, especially when MRI shows temporal lobe abnormalities.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Neurosyphilis, a tertiary stage of syphilis infection, can manifest with diverse neurological symptoms.
- Early diagnosis and treatment are vital for favorable outcomes, yet clinical presentation can be challenging.
Observation:
- A 37-year-old male presented with fever, disturbance of consciousness, and seizure.
- Brain MRI revealed abnormal hyperintensities in the bilateral temporal lobes.
- Positive treponemal and non-treponemal antibodies in serum and cerebrospinal fluid confirmed neurosyphilis.
Findings:
- The patient received intravenous penicillin G and methylprednisolone, leading to improvement in clinical symptoms, MRI findings, and cerebrospinal fluid analysis.
- Neurosyphilis cases with mesiotemporal encephalitis often present in young, HIV-negative individuals with subacute cognitive impairment and seizures.
Implications:
- Neurosyphilis diagnosis can be difficult due to non-specific symptoms like altered consciousness or seizures.
- Temporal lobe abnormalities on MRI should prompt consideration of neurosyphilis, facilitating timely and appropriate treatment.
