1/146. Cerebral gumma showing spontaneous regression on magnetic resonance imaging study--case report.A 75-year-old male presented with the complaint of headache. Magnetic resonance (MR) imaging demonstrated a low-signal intensity area on both T1- and T2-weighted images with ring-like enhancement and adhesion of the dura appearing as dural tail sign. Follow-up MR imaging demonstrated spontaneous regression, so the preoperative diagnosis was malignant lymphoma. Histological examination revealed typical granuloma. treponema pallidum hemagglutination assay tests of serum and cerebrospinal fluid were positive for active syphilis. The enhanced mass totally disappeared after 4 months of erythromycin therapy. The final diagnosis was cerebral gumma. The incidence of syphilis is increasing, so cerebral gumma should be included in the differential diagnosis of hypovascular tumors that involve both the parenchyma and dura even in the presence of spontaneous regression.- - - - - - - - - - ranking = 1keywords = syphilis (Clic here for more details about this article) |
2/146. Intractable epilepsy as the initial manifestation of neurosyphilis.A 29-year-old man experienced intractable partial seizures as the initial manifestation of neurosyphilis. The diagnosis was made after the onset of dementia 9 months later. Both the epilepsy and dementia resolved with penicillin therapy. Syphilis should be considered in patients with adult-onset focal epilepsy, particularly if there is associated dementia. Treatment may be successful even when the diagnosis is delayed.- - - - - - - - - - ranking = 2.5keywords = syphilis (Clic here for more details about this article) |
3/146. Not so slowly progressive visual loss.A 51-year-old man presented with bilateral progressive visual loss during a 2-month period. visual acuity was 20/60 in both eyes with bilateral constricted visual fields. Funduscopy revealed bilateral disk pallor and arteriolar attenuation. His vision declined rapidly during the next 2 weeks. Investigations showed a positive cerebrospinal fluid Venereal disease research Laboratory test (1:8). A diagnosis of neurosyphilis was made, and treatment was started with high-dose intravenous and intramuscular penicillin.- - - - - - - - - - ranking = 0.5keywords = syphilis (Clic here for more details about this article) |
4/146. Treatment of latent and tertiary syphilis.Although the efficacy of penicillin treatment for syphilis has been amply demonstrated, the optimal, curative dosage is still undefined. Some patients experience a third stage of the disease long after secondary-stage symptoms have resolved. Treatment differs in early and late latency and with the specific manifestations of tertiary-stage disease.- - - - - - - - - - ranking = 2.5keywords = syphilis (Clic here for more details about this article) |
5/146. Nonconvulsive status epilepticus resulting from Jarisch-Herxheimer reaction in a patient with neurosyphilis.We report a case of Jarisch-Herxheimer reaction in a patient with neurosyphilis, which was complicated by nonconvulsive status epilepticus. The EEG features suggested a focal seizure onset, although the patient's MRI was normal. JHR is common in the treatment of neurosyphilis, but usually produces only transient systemic constitutional symptoms. Neurologic deterioration is rare, but can be dramatic, as in our patient. NCSE should be considered as an explanation for persistent obtundation and transient focal neurologic findings in this setting.- - - - - - - - - - ranking = 3keywords = syphilis (Clic here for more details about this article) |
6/146. neurosyphilis as a cause of facial and vestibulocochlear nerve dysfunction: MR imaging features.The prevalence of syphilis increased for several decades before the mid-1990s in the united states, particularly in the southern states. We report a case of neurosyphilis causing bilateral facial and vestibulocochlear nerve dysfunction in which the diagnosis was not initially suspected based on the patient's demographics and history. The MR imaging features helped to make the diagnosis in this case and to exclude other possible causes of multiple cranial nerve dysfunction in this patient. hearing loss associated with neurosyphilis is one of the few treatable forms of progressive hearing loss, and it is essential that a diagnosis of neurosyphilis be made expeditiously.- - - - - - - - - - ranking = 4keywords = syphilis (Clic here for more details about this article) |
7/146. Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response.OBJECTIVE: To determine the relative frequencies of signs in posterior segment ocular syphilis, the response to a neurosyphilis regimen of penicillin, and differences in findings between human immunodeficiency virus (hiv)-coinfected and -noncoinfected patients in a community setting. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: Fourteen consecutive patients with posterior segment ocular syphilis over a 14-year period within or during the acquired immune deficiency syndrome era. INTERVENTION: neurosyphilis intravenous penicillin regimen. MAIN OUTCOME MEASURES: Initial and final visual acuity; treponemal and nontreponemal serologic analyses; cerebrospinal fluid cell count, protein, and Venereal disease research Laboratory analyses; posterior segment signs; and relapses and recurrences. RESULTS: Blacks and males were predominantly affected. Five (36%) of patients were hiv coinfected, and ocular syphilis led to the hiv infection diagnosis in three. Four (29%) patients had received previous antibiotic therapy for primary or secondary syphilis, raising the suspicion of relapse. Two patients had negative nontreponemal serologic results. All patients responded rapidly to neurosyphilis therapy. One patient subsequently relapsed after neurosyphilis therapy, and a second was reinfected with recurrence of ocular involvement. One previously undescribed retinal manifestation was discovered: a sectorial retinochoroiditis with delayed retinal circulation in the involved area. CONCLUSIONS: Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection. Conventional syphilis staging is of little use in understanding ocular syphilis. A high suspicion for this diagnosis is appropriate, especially in poorer black males with posterior segment inflammatory disease. Human immunodeficiency virus coinfection with ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term. awareness of the multiple presentations of posterior segment ocular syphilis will aid ophthalmologists in averting misdiagnosis or delayed diagnosis.- - - - - - - - - - ranking = 12keywords = syphilis (Clic here for more details about this article) |
8/146. Mesiotemporal T2-weighted hyperintensity: neurosyphilis mimicking herpes encephalitis.Bilateral mesiotemporal hyperintensity on T2-weighted and fluid-attenuated inversion recovery MR images of a patient with a clinical syndrome of encephalitis is considered to be a classic finding for herpes simplex virus infection. We report a case of neurosyphilis with identical MR imaging abnormalities and a similar clinical presentation. Because syphilis is not routinely tested for, awareness of this mimicry of herpes simplex virus encephalitis is important, considering the potential therapeutic implications.- - - - - - - - - - ranking = 3keywords = syphilis (Clic here for more details about this article) |
9/146. neurosyphilis presenting as schizophrenialike psychosis.OBJECTIVE: The authors present a 30-year-old pregnant and previously healthy woman with sudden onset of agitation, delusions, and frontal lobe dementia. serum and cerebrospinal fluid findings revealed the presence of untreated syphilis. BACKGROUND: neurosyphilis can present a variety of behavioral symptoms, including mania, depression, and psychosis. METHOD: A neuropsychiatric and neurologic workup was performed before the start of antibiotic treatment. The status of the patient was observed throughout the course of her hospital stay for 7 months. Additionally, a neuropsychological evaluation was administered before treatment, and 2 weeks and 4 months after treatment. RESULTS: After treatment of neurosyphilis, steady improvements were noted in psychotic and cognitive symptoms. By the end of 7 months, and after discontinuation of antipsychotic medication, no psychiatric symptoms were evident. CONCLUSIONS: This case emphasizes the importance of considering neurosyphilis in the differential diagnosis of acute psychosis. Furthermore, this case shows the dramatic improvement in psychiatric symptoms and cognitive dysfunction in response to the treatment of neurosyphilis.- - - - - - - - - - ranking = 4.5keywords = syphilis (Clic here for more details about this article) |
10/146. Syphilitic posterior uveitis: correlative findings and significance.Twenty-one patients with syphilitic posterior uveitis were investigated retrospectively to study the disease spectrum, associations with neurosyphilis, and therapeutic implications. Ophthalmologic manifestations of syphilitic posterior uveitis are differentiated into acute and chronic uveitides. The several distinct acute uveitic syndromes are usually florid and are associated with early syphilis, with VDRL-positive syphilitic meningitis, and frequently with human immunodeficiency virus coinfection. The chronic posterior uveitides are often insidious, a manifestation of late syphilis, and associated commonly with subclinical neurosyphilis. All patients with acute cases and 54% of patients with chronic cases in our study received penicillin therapy appropriate for neurosyphilis. The frequent association of syphilitic posterior uveitis with neurosyphilis and the analogous spirochetal sequestration beyond the blood-brain and the blood-ocular barriers suggest that all patients with syphilitic posterior uveitis, irrespective of ocular disease intensity, should undergo evaluation of cerebrospinal fluid and be treated with penicillin regimens appropriate for neurosyphilis.- - - - - - - - - - ranking = 3.5keywords = syphilis (Clic here for more details about this article) |
| | Next -> |