A 51-year-old man presented with memory loss, behavioral changes, and generalized seizures for 4 months. Mini-Mental State Examination (MMSE) score was 11. MRI showed hyperintensities in multiple cortical areas and thalami (figure, A–C). Diffusion was restricted in certain areas (figure, D and E). Treponemal antibody tests were positive in serum and CSF. He was treated with penicillin. Six months later, his behavior and memory improved considerably (MMSE 20).
Axial fluid-attenuated inversion recovery images (A–C) show hyperintensity of bilateral mesial temporal structures, insula, pulvinar of the thalami, and right temporo-occipital cortex. Isotropic trace diffusion-weighted imaging (D) and apparent diffusion coefficient (E) maps show restricted diffusion in the right temporo-occipital cortex and right insula.
Viral encephalitides, Wernicke encephalopathy, and prion diseases are included in differential diagnosis of these radiologic findings. This case shows that neurosyphilis can mimic these neuroimaging findings in addition to others.1 A clinical suspicion for neurosyphilis is crucial for diagnosis.
AUTHOR CONTRIBUTIONS
Nergiz Ağayeva contributed to manuscript preparation, data analysis, and interpretation of clinical data. Kader K. Oguz contributed to analysis and interpretation of radiologic data. Esen Saka has contributed to conceptualization of the study and revising the manuscript.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2013 American Academy of Neurology
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.