CT and MR findings in HIV-negative neurosyphilis.
OBJECTIVE
The purpose of this study was to describe and evaluate neuroimaging findings of patients with neurosyphilis.


METHODS
The neuroimaging studies of 14 patients with documented neurosyphilis were reviewed. Diagnosis was established in 14 patients with cerebrospinal fluid for a Treponema Pallidum Particle Agglutination (TPPA) test. All patients had reactive TPPA and Unheated Serum Regain test (USR) in their sera. Imaging studies included plain, contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, and MR angiography.


RESULTS
In the 14 HIV-negative patients with neurosyphilis, CT and MR showed the presence of cerebral infarction in six cases, arteritis in four cases, nonspecific white matter lesion in three cases, acute syphilitic meningitis in one case and normal neuroimaging finding in one case. In addition, 4 in 14 patients had general paresis, and MRI showed high signal intensity on T2 -weighted images involving frontotemporal lobes, hippocampus and periventricular area. Treatment with penicillin significantly diminished the size of these high signal intensity on T2-weighted images with general paresis.


CONCLUSIONS
These results suggest that MR and CT images have some characteristic manifestations in patients of neurosyphilis. Because early diagnosis and treatment of neurosyphilis are crucial to avoid persistent brain damage, the neuroimaging findings are valuable adjunct to clinical diagnosis and to provide useful information to follow-up after therapy.
Peng
Fuhua
F
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630 Guangdong Province, China. pfh93@21cn.com
Hu
Xueqiang
X
Zhong
Xiufeng
X
Wei
Qiu
Q
Jiang
Ying
Y
Bao
Jian
J
Wu
Aimin
A
Pei
Zhong
Z
D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D003287:Contrast Media; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D010291:Paresis / Q000209:etiology; D010406:Penicillins / Q000627:therapeutic use; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D010406:Penicillins