Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging.

BACKGROUND: This article reports a rare case of active neurosyphilis in a man with mild to moderate dementia and marked hippocampal atrophy, mimicking early onset Alzheimer's disease. Few cases have so far described bilateral hippocampal atrophy mimicking Alzheimer's disease in neurosyphilis. CASE PRESENTATION: The patient presented here is a 33 year old Bulgarian male, whose clinical features include progressive cognitive decline and behavioral changes over the last 18 months. Neuropsychological examination revealed mild to moderate dementia (Mini Mental State Examination score was 16/30) with impaired memory and attention, and executive dysfunction. Pyramidal, and extrapyramidal signs, as well as dysarthria and impairment in coordination, were documented. Brain magnetic resonance imaging showed cortical atrophy with noticeable bilateral hippocampal atrophy. The diagnosis of active neurosyphilis was based on positive results of the Venereal Disease Research Laboratory test/Treponema pallidum hemagglutination reactions in blood and cerebrospinal fluid samples. In addition, cerebrospinal fluid analysis showed pleocytosis and elevated protein levels. High-dose intravenous penicillin therapy was administered. At 6 month follow up, improvements were noted clinically, on neuropsychological examinations, and in cerebrospinal fluid samples. CONCLUSION: This case underlines the importance of early diagnosis of neurosyphilis. The results suggest that neurosyphilis should be considered when magnetic resonance imaging results indicate mesiotemporal abnormalities and hippocampal atrophy. Neurosyphilis is a treatable condition which requires early aggressive antibiotic therapy.

Cognitive dysfunction profile and arterial stiffness in type 2 diabetes.

BACKGROUND: The causative mechanisms of type 2 diabetes (T2D) on cognitive dysfunction are still undergoing development. AIM: To explore the cognitive dysfunction profile and its relation to the potential role of arterial stiffness in later middle age T2D patients. METHODS: We studied 37 patients with T2D (age range 45-65 years) and 22 normal controls. All participants underwent comprehensive neuropsychological assessment. The carotid-femoral pulse wave velocity (CF-PWV) measurements were taken with the PulsePen device. RESULTS: Our results showed significantly poorer performance on all tests assessing attention/executive functions and processing speed in patients with T2D. In addition to cognitive slowing T2D patients demonstrated significant deficits in almost all measures of verbal episodic memory after adjustment for age, education and blood pressure (BP) levels (p<0.05). Carotid-femoral pulse wave velocity (CF-PWV) appeared significantly higher in T2D subjects than in normal controls after adjustment for age and BP level (p<0.001). Significant relationship was observed between CF-PWV and cognitive status. CONCLUSION: We revealed that arterial stiffness was increased and associated with cognitive impairment in T2D. The cognitive profile indicates hippocampal amnestic type mild cognitive impairment associated with a pronounced dysexecutive syndrome suggesting that diabetes may affect cognition through both vascular and neurodegenerative processes. However, neurodegenerative cognitive profile caused by hippocampal atrophy in a pure vascular process could not be excluded.