Intracranial vascular manifestations of neurosyphilis: a single-center case series

Due to its wide range of symptoms and often ambiguous presentation, establishing a definitive diagnosis of neurosyphilis remains a significant challenge. This study aims to illustrate the diagnostic value of vascular imaging in patients with neurosyphilis.

We retrospectively reviewed the medical records of neurosyphilis patients at a single institution from January 2010 to May 2024. After applying exclusion criteria, a total of 18 patients (14 males and 4 females) who met the diagnostic criteria and had vessel imaging were included.

Patients presented with various neurological symptoms, which were categorized into focal neurological, gait and motor, cognitive and psychiatric, and other symptoms. On vascular imaging, the most common lesions were stenosis (n = 9, 50%), followed by luminal irregularity (n = 5, 27.8%) and aneurysm (n = 3, 16.7%). While a clear link between presenting symptoms and vascular lesions was demonstrable in some cases, other cases showed no direct correlation between clinical symptoms and imaging findings.

These cases underscore the persistent diagnostic challenges that require a comprehensive approach. Our study highlights that an interdisciplinary approach, integrating clinical, laboratory, and imaging data, is essential for an accurate diagnosis of neurosyphilis.