title: Clinical and imaging findings in patients with neurosyphilis: a study of a cohort and review of the literature.
abstract: BACKGROUND
  Most patients with neurosyphilis are considered asymptomatic. The diagnosis is challenging and the role of neuroimaging is not yet well established. The present study was conducted to focus on the clinical findings and further characterize the imaging features of the disease, along with a review of the pertinent literature.
  
  
  METHODS
  Six male patients with neurosyphilis based on abnormal cerebrospinal fluid findings, five of whom were asymptomatic at presentation, underwent cranial computerized tomography (CT) and magnetic resonance imaging (MRI). They also underwent a complete physical, neurological, and ophthalmological examination, with special attention paid to atherosclerotic vascular risk factors. In addition, all were examined for cardiac involvement using electrocardiography and cardiac ultrasound.
  
  
  RESULTS
  The meticulous neurological and ophthalmological examination revealed abnormalities in five patients, most commonly cranial nerve involvement (three patients) and hemiparesis (two patients). The CT and MRI studies revealed abnormalities in five of the six patients, and in all six patients, respectively. The most common findings were brain infarcts, which were demonstrated in four of the six patients. MRI was found to be more sensitive than CT in detecting these brain infarcts, as expected.
  
  
  CONCLUSIONS
  Vascular insult was the most common neuroimaging finding in our patients with neurosyphilis, probably due to meningovascular endarteritis. Neurosyphilis should always be considered in young patients with unexplained brain infarcts.
authors.affiliation: Department of Dermatology, Rambam Health Care Campus and the Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Khamaysi
authors.forename: Reuven
authors.initials: R
authors.lastname: Bergman
authors.forename: Gregory
authors.initials: G
authors.lastname: Telman
authors.forename: Dorith
authors.initials: D
authors.lastname: Goldsher
mesh_terms: D000328:Adult; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000382:microbiology; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000382:microbiology; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009460:Neurologic Examination; D009494:Neurosyphilis / Q000150:complications* / Q000000981:diagnostic imaging*; D010291:Paresis / Q000175:diagnosis / Q000382:microbiology; D014057:Tomography, X-Ray Computed