Neurosyphilis with unilateral optic tract lesion causing homonymous hemianopia.
BACKGROUND
Homonymous hemianopia is not a rare symptom. Many causative lesions and pathologies are known, although a unilateral optic tract lesion caused by syphilis is rare.


METHODS
A 56-year-old woman developed a congruous right homonymous hemianopia and bilateral tonic pupils with irregular shape. Brain T2-weighted and fluid attenuated inversion recovery magnetic resonance imaging (MRI) revealed a spindle-like high-intensity lesion in her left postchiasmal optic tract. The rim of this lesion enhanced with gadolinium without meningeal enhancement. Serum and cerebrospinal fluid venereal disease research laboratory tests were positive. Cerebrospinal fluid contained 71 white blood cells/microL (mononuclear cells = 97%) and 48 mg/dL of protein. The hemianopia disappeared after administration of benzylpenicillin.


CONCLUSIONS
Neurosyphilis should be added to the list of differential diagnoses for an isolated optic tract lesion.
Iwamoto
Kohnosuke
K
Department of Neurology, Toho University Medical Center Omori Hospital, Tokyo, Japan.
Aoyagi
Joe
J
Kiyozuka
Tetsuhito
T
Iwasaki
Yasuo
Y
Fujioka
Toshiki
T
D005260:Female; D007839:Functional Laterality; D006423:Hemianopsia / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications* / Q000382:microbiology; D014210:Treponema pallidum / Q000472:pathogenicity; D014795:Visual Pathways / Q000293:injuries* / Q000382:microbiology