Three cases of neurosyphilis with mesiotemporal lobe lesions: analysis of the clinical presentations,neuroimaging features and pathogenesis / 中华神经科杂志

ABSTRACT

Objective To report the clinical and neuroimaging features in three cases of neurosyphilis with mesiotemporal lobe lesions; and to discuss possible pathogenesis and differential diagnosis.Methods The clinical manifestations,laboratory examinations,neuroimaging features,differential diagnosis and curative effect of 3 cases of neurosyphilis with mesiotemporal lobe lesions were analyzed retrospectively.The possible pathogenesis was discussed.Results All of 3 cases had positive and high titer index of syphilis in both serum and cerebrospinal fluid.The onset symptom was abnormal cognitive functions with acute aggravation or rapid progression.Cerebrospinal fluid analysis implied lymphocyte predominant inflammatory reaction with increased protein.Electroencephalography showed localized slow waves as to the lesions.On brain magnetic resonance imaging,unilateral or asymmetrical bilateral mesiotemporal lobe was affected with long T2 signal.Herpes simplex virus encephalitis and paraneoplastic limbic encephalitis should beconsidered in differential diagnosis.The symptoms and laboratory indexes improved significantly after anti-syphilis treatment.Conclusions Neurosyphilis should be evaluatedin a patient with onset of abnormal cognitive functions and having mesiotemporal lobe lesions on magnetic resonance imaging.Promptly diagnosis and early treatment could achieve good prognosis.