PT  - JOURNAL ARTICLE
AU  - Tiwana, Harmanpreet
AU  - Ahmed, Aiesha
TI  - Neurosyphilis with unique neuroimaging findings (P1.308)
DP  - 2017 Apr 18
TA  - Neurology
PG  - P1.308
VI  - 88
IP  - 16 Supplement
4099  - http://n.neurology.org/content/88/16_Supplement/P1.308.short
4100  - http://n.neurology.org/content/88/16_Supplement/P1.308.full
SO  - Neurology2017 Apr 18; 88
AB  - Objective: Consider Neurosyphilis in differential of mesial temporal lobe white matter changes.Background: Common causes of temporal lobe hyperintensities are CNS infections like herpes simplex encephalitis, Lyme disease, limbic encephalitis and vascular pathology like CADASIL.Design/Methods: Personal assessment, laboratory data analysis and neuroimaging for the patient admitted in central Pennsylvania tertiary care referral center were done. CSF showed nucleated cells with lymphocytic pleocytosis. Lyme serologies, HSV and RPR (for history of sexual promiscuity) were sent. Work up with MRI showed hyperintensities in temporal white matter.Results: 52 year old male presented with one year history of diffuse dysesthesia in upper and lower extremities. Associated symptoms consisted of intermittent headaches and neck stiffness. Evaluation with Lumbar Puncture showed increased nucleated cells (50) with lymphocytic predominance (96%) and elevated protein of 109. MRI of Brain showed T2/FLAIR hyper intensity in bilateral subcortical temporal white matter, left greater than right and associated volume loss in cerebral parenchyma. Additional abnormal work up results included reactive serum RPR and Treponema pallidum antibody particle agglutination. Diagnosis of Neurosyphilis was made and patient was treated with Ceftriaxone for 3 weeks. At the time of discharge his headache and neck stiffness resolved, dysesthesias were decreased in intensity. MRI findings here revealed T2/FLAIR hyper intensities with generalized cerebral atrophy. In addition to MRI, the diagnosis is based on CSF lymphocytic pleocytosis, and reactive treponemal or non-treponemal test. Our patient had both mild atrophy and temporal changes.Conclusions: Neuroimaging findings of neurosyphilis commonly are cerebral infarctions, leptomeningeal enhancement or nonspecific white matter lesions. Less common features on a fluid-attenuated inversion recovery (FLAIR) sequences are cortical atrophy and mesial temporal parenchymal signal changes. It is prudent to keep Neurosyphilis in differential of mesial temporal lobe white matter changes as early diagnosis and treatment results in better prognosis.Study Supported by: NoneDisclosure: Dr. Tiwana has nothing to disclose. Dr. Ahmed has nothing to disclose.