Berger J R, Waskin H, Pall L, Hensley G, Ihmedian I, Post M J
Department of Neurology, University of Miami School of Medicine, FL 33136.
Neurology. 1992 Jul;42(7):1282-7. doi: 10.1212/wnl.42.7.1282.
We describe two human immunodeficiency virus (HIV)-infected patients with syphilitic cerebral gummas. Both patients presented with a seizure disorder associated with an isolated, peripherally located, contrast-enhancing lesion of the brain on CT. Cranial MRI performed on one patient revealed dural thickening in the region of the lesion. A brain biopsy in that patient revealed a lymphoplasmacytic infiltrate with extensive perivascular inflammation. Clinical manifestations, radiographic resolution of the lesions, and a decline in nontreponemal serologic tests for syphilis followed high-dose aqueous penicillin therapy in both patients. These patients illustrate that (1) cerebral mass lesions occurring with HIV infection may result from syphilis; (2) seizures may be the presenting manifestation of this form of neurosyphilis; and (3) high-dose, intravenous, aqueous penicillin is effective in treating these lesions.
我们描述了两名感染人类免疫缺陷病毒（HIV）的梅毒脑树胶肿患者。两名患者均表现为癫痫发作，CT显示脑部有一个孤立的、位于外周的、有强化的病灶。对其中一名患者进行的头颅MRI显示病灶区域硬膜增厚。该患者的脑活检显示淋巴细胞和浆细胞浸润，并伴有广泛的血管周围炎症。两名患者在接受大剂量水剂青霉素治疗后，临床表现、病灶的影像学消退以及梅毒非梅毒螺旋体血清学检测结果均有所下降。这些患者表明：（1）HIV感染时出现的脑部占位性病变可能由梅毒引起；（2）癫痫发作可能是这种神经梅毒的首发表现；（3）大剂量静脉注射水剂青霉素对治疗这些病灶有效。
