title: Neurosyphilis presenting with status epilepticus.
abstract: Three patients with neurosyphilis are reported. The first and third patients presented with convulsive status epilepticus and the second with non-convulsive status after penicillin administration. In all cerebrospinal fluid and the serum Venereal Disease Research Laboratory Test (VDRL) and Treponema Pallidum hemagglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-ABS) were positive, but HIV serology was negative. Their EEGs showed periodic, lateralized, epileptiform discharges (PLEDs) just after SE. The first and third patients had no history of epilepsy. Seizures started as focal motor attacks but then secondarily generalized. The first patient's cranial MRI showed cerebral atrophy and hyperintensity involving bilateral medial and anterior temporal regions, more prominent on the left and which disappeared after penicillin treatment. The second case, after receiving penicillin, had nonconvulsive SE, a clinical presentation suggesting a Jarisch-Herxheimer reaction (JHR). Her cranial MR revealed moderate cortical atrophy and widespread confluent hyperintense foci mainly in both periventricular areas, corona radiata and centrum semiovale. MRI of the third case showed a large, left sylvian, arachnoid cyst without mass effect. Executive dysfunction was observed in follow-up neuropsychological tests in all patients. When investigating status epilepticus, neurosyphilis as a cause must not be forgotten.
authors.affiliation: Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi Capa, 34390 Istanbul, Turkey. candan.gurses@gmail.com
authors.forename: Candan
authors.initials: C
authors.lastname: Gürses
authors.forename: Murat
authors.initials: M
authors.lastname: Kürtüncü
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jirsch
authors.forename: Nilüfer
authors.initials: N
authors.lastname: Yeşilot
authors.forename: Haşmet
authors.initials: H
authors.lastname: Hanağasi
authors.forename: Nerses
authors.initials: N
authors.lastname: Bebek
authors.forename: Betül
authors.initials: B
authors.lastname: Baykan
authors.forename: Murat
authors.initials: M
authors.lastname: Emre
authors.forename: Ayşen
authors.initials: A
authors.lastname: Gökyiğit
authors.forename: Frederick
authors.initials: F
authors.lastname: Andermann
mesh_terms: D000328:Adult; D000368:Aged; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D009494:Neurosyphilis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D010406:Penicillins / Q000009:adverse effects*; D013226:Status Epilepticus / Q000209:etiology*
chemical_list: D010406:Penicillins