Investig Magn Reson Imaging.  2019 Sep;23(3):279-282. 10.13104/imri.2019.23.3.279.

A Rare Case of Syphilitic Myelitis of the Spinal Cord

• Kim JH
• Jeong HS
• Park C
• Ryu H
• Roh JE
• Yeom JA
• Kim TU

• KMID: 2459884
• DOI: http://doi.org/10.13104/imri.2019.23.3.279

Abstract

Neurosyphilis is an infection of the brain or spinal cord that is caused by the bacterium Treponema pallidum. Syphilitic myelitis, which involves the spinal cord, is a very rare form of neurosyphilis seen in patients with syphilis. It requires differentiation from other diseases of the spinal cord, including idiopathic transverse myelitis and spinal cord infarction. Herein, we describe the presentation and diagnosis of syphilitic myelitis in a 43-year-old woman, based on a flip-flop sign and candle guttering appearance depicted in magnetic resonance imaging and laboratory tests.

Keyword

Magnetic resonance imaging (MRI); Neurosyphilis; Syphilitic myelitis

MeSH Terms

Adult
Brain
Diagnosis
Female
Humans
Infarction
Magnetic Resonance Imaging
Myelitis*
Myelitis, Transverse
Neurosyphilis
Spinal Cord*
Syphilis
Treponema pallidum

Figure

• 

  Fig. 1 Magnetic resonance imaging of the thoracic spine of a 43-year-old woman who experienced sudden weakness of the left lower leg while climbing stairs. The T2-weighted (a) axial and (b) sagittal images depicting high signal intensity lesions throughout the thoracic spinal cord level and heterogeneous low signal intensity lesions (arrows) at the T6–T7 spinal cord level. Superficial intramedullary enhancement (arrowheads), which shows a “candle guttering appearance”, can be seen in the enhanced fat-suppressed T1-weighted (c) axial and (d) sagittal images. The “flip-flop sign” (arrow and arrowhead) is seen, which shows that the abnormal enhancement is reduced on the T2-weighted images. The diffusion-weighted (e) axial and (f) sagittal images do not depict restriction.

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