Neurosyphilis: A Clinico- Radiological Study

Abstract

Purpose Neurosyphilis is an uncommon disease. Although syphilis may promote the transmission of HIV the converse may not be true. The neuro-radiology of neurosyphilis is limited to two case series and several case reports. Our series of patients were reviewed to describe the clinical and radiological findings. Method A retrospective chart review from 1994 to 2005 was done and demographic, clinical, laboratory and radiological findings were extracted. Patients HIV status was also recorded. Patients who satisfied the criteria for the diagnosis of neurosyphilis with the exclusion of alternate diagnoses were included. Results Fifty-three patients were evaluated but only 41 charts were available for review. Thirty-nine of these had radiological data. The clinical spectrum included asymptomatic patients, strokes, dementia, cranial nerve palsies, spinal cord syndromes and polyradiculopathy. Imaging changes included normal findings, infarcts, meningeal based mass lesions, spinal intra-medullary hyper-intensities, cranial nerve enhancement and intra-medullary enhancing mass lesions. There was no difference in CSF cellular or chemistry findings between those with neurosyphilis who were HIV positive and those who were HIV negative. Amongst the patients where follow up was available most improved regardless of HIV status. Conclusion Neurosyphilis has protean manifestations and can affect any central neurological system. The pathogenesis varies from inflammatory mass lesions to vascular occlusion and inflammatory damage. Syphilis should be an aetiological consideration in any neurological presentation where another cause is not obvious. The radiological features are not specific and would be seen with many inflammatory aetiologies affecting the CNS. The CSF picture is similar regardless of HIV status and patients should be managed similarly regardless of their HIV status. Objectif La neurosyphilis est une maladie peu commune. Bien que la syphilis puisse promouvoir la transmission du HIV, l\'inverse n\'est pas vrai. Les aspects neuromatologiques de la neurosyphilis sont extremement rares , limitees a deux series et la publication de quelques cas. Notre objectif est de revoir les aspects cliniques et radiologiques de nos patients, Methode Il s\'agit d\'une etude retrospectives allant de 1994 a 2005 avec prise en compte des aspects demographiques, cliniques, biologiques et radiologiques. Les patients VIH positifs ont ete inclus dans l\'etude, Resultat 53 patients ont ete evalues mais seuls 41 dossiers ont pu etre etudies. 39 de ces donnees disposaient d\'informations radiologiques exploitables. Le tableau clinique etait variable : patient asymptomatique, AVC, demence, paralysie des nerfs crâniens, atteinte medullaire et polyradiculopathie. Les aspects a l\'imagerie etaient egalement proteiformes : aspect normal, infarcissement, masses expansives meningees, hypersignaux intramedullaires, rehaussement des nerfs crâniens et tumeur intra-medullaire . Il n\'y avait pas de difference de cellularite dans le LCS entre les patients HIV positifs et HIV negatifs. Conclusion Les aspects de la neurosyphilis sont multiples et peuvent interesser a la fois le systeme nerveux central et peripherique. La pathogenie est variable allant d\'une masse inflammatoire a une occlusion vasculaire et des lesions inflammatoires. La syphilis devrait etre une etiologie a evoquer dans toute manifestation neurologique pour lesquelles il n\'y a pas de causes evidentes. Les aspects radiologiques ne sont pas specifiques par rapport aux autres etiologies inflammatoires affectant le systeme nerveux central. Il n\'y a pas de difference dans les perturbations du LCS entre les malades seropositifs et seronegatifs qui sont atteints de neurosyphilis. Keywords : HIV, Neurosyphilis, Radiology. African Journal of Neurological Sciences Vol. 27 (1) 2008: pp.41-45