title: Cerebral syphilitic gummata: a case presentation and analysis of 156 reported cases.
abstract: OBJECTIVE
  Cerebral syphilitic gummata are rare manifestations of tertiary, meningovascular syphilis. No extensive characterization of these lesions has been published recently, and only a few small reviews containing imaging findings have been published to date. To better characterize cerebral gummata, we present a case seen at Tulane University, followed by an extensive review of the literature.
  
  
  METHODS
  A 56-year-old man with a history of treated syphilis presented with seizures and confusion. A rapid plasma reagin titer was reactive in serum but Venereal Disease Research Laboratory results were negative in cerebrospinal fluid. Neuroimaging demonstrated an occipital lesion and the patient underwent subtotal resection. The pathological examination demonstrated a syphilitic gumma containing Treponema pallidum visualized by fluorescence immunostaining.
  
  
  METHODS
  An extensive literature search was performed for published case reports of cerebral gummata.
  
  
  RESULTS
  One hundred fifty-six cases containing 185 lesions were located. Patients presented with signs and symptoms based on location. Lesions are more common in men (64%) and those aged 18 to 39 years. Cerebrospinal fluid syphilis tests were positive in 64%. Lesions are located everywhere but are most common on the convexities (66%). Computed tomography usually reveals a hypodense lesion that enhances. Magnetic resonance imaging usually demonstrates hypointensity on T1, hyperintensity on T2, and enhancement with gadolinium. Most patients are responsive to antiluetic therapy, with the majority demonstrating complete or near-complete imaging and symptom resolution.
  
  
  CONCLUSIONS
  Cerebral gummata are rare lesions. Intravenous penicillin G with imaging follow-up is recommended for most patients. Surgery should be reserved for those unresponsive to antibiotics or those with acutely elevated intracranial pressure.
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida 32610-0265, USA. kyle.fargen@neurosurgery.ufl.edu
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Alvernia
authors.forename: Christine S
authors.initials: CS
authors.lastname: Lin
authors.forename: Miguel
authors.initials: M
authors.lastname: Melgar
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000628:therapy*; D010400:Penicillin G / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010400:Penicillin G