Neurosyphilis: a Clinico-Radiological Study

ABSTRACT

Purpose. Neurosyphilis is an uncommon disease. Although syphilis may promote the transmission of HIV the converse may not be true. The neuro-radiology of neurosyphilis is limited to two case series and several case reports. Our series of patients were reviewed to describe the clinical and radiological findings. Method. A retrospective chart review from 1994 to 2005 was done and demographic; clinical; laboratory and radiological findings were extracted. Patients HIV status was also recorded. Patients who satisfied the criteria for the diagnosis of neurosyphilis with the exclusion of alternate diagnoses were included. Results. Fifty-three patients were evaluated but only 41 charts were available for review. Thirty-nine of these had radiological data. The clinical spectrum included asymptomatic patients; strokes; dementia; cranial nerve palsies; spinal cord syndromes and polyradiculopathy. Imaging changes included normal findings; infarcts; meningeal based mass lesions; spinal intra-medullary hyper-intensities; cranial nerve enhancement and intra-medullary enhancing mass lesions. There was no difference in CSF cellular or chemistry findings between those with neurosyphilis who were HIV positive and those who were HIV negative. Amongst the patients where follow up was available most improved regardless of HIV status. Conclusion. Neurosyphilis has protean manifestations and can affect any central neurological system. The pathogenesis varies from inflammatory mass lesions to vascular occlusion and inflammatory damage. Syphilis should be an aetiological consideration in any neurological presentation where another cause is not obvious. The radiological features are not specific and would be seen with many inflammatory aetiologies affecting the CNS. The CSF picture is similar regardless of HIV status and patients should be managed similarly regardless of their HIV status