RESUMO
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.
Assuntos
Humanos , Pessoa de Meia-Idade , Encéfalo , Artérias Cerebrais , Infarto Cerebral , Constrição Patológica , Doenças dos Nervos Cranianos , Nervos Cranianos , Diagnóstico , HIV , Imageamento por Ressonância Magnética , Meninges , Meningite , Neurossífilis , Artéria Cerebral Posterior , Medula Espinal , Coluna Vertebral , Spirochaetales , Sífilis , Tabes Dorsal , Treponema pallidum , Nervo VestibulococlearRESUMO
Se presenta el caso clínico de un paciente de 54 años, negativo para VIH, con enfermedad cerebrovascular por trombosis de la arteria basilar, secundaria a neurosífilis meningovascular. La neurosífilis es el compromiso del sistema nervioso central por Treponema pallidum subespecie pallidum en cualquier estadio de la entidad e incluye las formas asintomáticas y sintomáticas de la infección; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. La recomendación actual es el tratamiento con 4 millones de unidades de penicilina cristalina cada 4 horas por 14 días.
Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Meningite/etiologia , Neurossífilis/complicações , Trombose/etiologia , Vasculite/etiologia , Insuficiência Vertebrobasilar/etiologia , Alcoolismo/complicações , Antibacterianos/uso terapêutico , Terapia Combinada , Disartria/etiologia , Emergências , Procedimentos Endovasculares , Soronegatividade para HIV , Hipertensão/complicações , Imageamento por Ressonância Magnética , Meningite/tratamento farmacológico , Neurossífilis/tratamento farmacológico , Paresia/etiologia , Penicilina G/uso terapêutico , Stents , Trombectomia , Tomografia Computadorizada por Raios X , Trombose/tratamento farmacológico , Trombose , Trombose/cirurgia , Vasculite/tratamento farmacológico , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar , Insuficiência Vertebrobasilar/cirurgiaRESUMO
Objective To evaluate the value and limitation of MRI in the diagnosis of meningovascular neurosyphilis. Methods Five cases of neurosyphilis confirmed by clinical history/laboratory were examined with MRI (3 plain MRI, 2 enhanced MRI). The results of blood and CSF TPPA/RPR were positive and HIV was negative. Results Abnormal signals were demonstrated in the temporal lobe in 3 cases, and infarction was revealed in the basal ganglion and periventricular white matter in another 2 cases. There was no marked contrast enhancement in the 2 cases. Conclusion Meningovascular neurosyphilis has no characteristic features on MRI, but MRI is an effective method in delineating the size, range, and characters of neurosyphilis, and it is also an useful modality to follow-up after antibiotic therapy.