July 16, 2012
A 46-year-old HIV-negative man with six-month history of personality disturbances, somnolency, and aphasia.
Neurosyphilis
- Caused by the spirochete Treponema pallidum.
- Resurgence of disease seen especially in HIV-positive individuals.
- One-third of untreated patients who progress to tertiary syphilis will have neurosyphilis.
- Symptomatic cases divided into four types based on clinical presentation: meningeal, vascular, general paresis, and tabes dorsalis.
- Key Diagnostic Features: Mild-to-moderate atrophy, cortical and subcortical infarctions, white matter lesions, gummata, leptomeningeal enhancement, vasculitis. Rarely, mimics herpes encephalitis with temporal lobe involvement. (In this case: VDRL +)
- DDx: Herpes encephalitis, tumor, complex partial epilepsy, paraneoplastic syndrome, hypoglycemia
- Rx: Penicillin
