J Korean Soc Magn Reson Med.  2014 Sep;18(3):263-268. 10.13104/jksmrm.2014.18.3.263.

Meningovascular and Spinal form of Neurosyphilis Presenting as Multiple Cranial Nerve Palsy, Cerebral Infarction and Meningomyelitis in a Human Immunodeficiency Virus Negative-Patient: MR Imaging Features

• Hong JH
• Lee HY
• Lim MK
• Kang YH
• Lee KH
• Cho SG

• KMID: 1999927
• DOI: http://doi.org/10.13104/jksmrm.2014.18.3.263

Abstract

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.

Keyword

Neurosyphilis; Meningovascular neurosyphilis; Syphilitic myelitis; Syphilitic meningomyelitis; Meningitis; Multiple cranial nerves

MeSH Terms

Brain
Cerebral Arteries
Cerebral Infarction*
Constriction, Pathologic
Cranial Nerve Diseases*
Cranial Nerves
Diagnosis
HIV*
Humans
Magnetic Resonance Imaging*
Meninges
Meningitis
Middle Aged
Neurosyphilis*
Posterior Cerebral Artery
Spinal Cord
Spine
Spirochaetales
Syphilis
Tabes Dorsalis
Treponema pallidum
Vestibulocochlear Nerve

Figure

• 

  Fig. 1 Brain MRI of a 53-year-old man with neurosyphilis. Postcontrast axial T1-weighted images show multiple enhancements at a. The right trigeminal nerve and the Meckel's cave (arrow), b. The right facial and vestibulocochlear nerves (arrows), the right cochlea (arrow head), c, d. The optic nerves and the chiasm (short arrow). Either nodular or ring enhancing lesions are seen at basal cistern (arrow heads), left sylvian fissure (curved arrow), pituitary stalk and hypothalamus (long arrow), along with thin leptomeningeal enhancement along the basal cistern and the brain stem. e. A contrast-enhanced MRA shows a segmental stenosis at the M1 portion of the right middle cerebral artery (arrow).

• 

  Fig. 2 Spine MRI of the patient. a. An axial T2-weighted image demonstrates a centrally located hyperintense lesion in the spinal cord at the T7 level (arrow). b. A postcontrast T1-weighted image depicts a patchy enhancing focus (arrow) in the cord that showed a T2 hyperintensity. c, d. Sagittal T2-weighted and postcontrast T1-weighted images show clumped nerve roots at the L1 level with nodular meningeal enhancement (arrows). e. A diffuse meningeal enhancement is seen along the surface of the lumbar and lower thoracic cord and the cauda equine (arrow heads).

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