Ishihara Tomohiko, Ishihara Ayako, Ozawa Tetutaro, Sanpei Kazuhiro, Shimohata Takayoshi, Nishizawa Masatoyo
Department of Neurology, Brain Research Institute, Niigata University.
Rinsho Shinkeigaku. 2015;55(4):238-42. doi: 10.5692/clinicalneurol.55.238.
A 60-year-old man presented with progressive dementia and generalized convulsions. An initial MRI revealed a widespread high-intensity area with a mass effect in the right frontal and temporal lobes on T2-weighted images. Findings on digital subtraction angiography were normal. Serum and CSF tests showed high titers of antibodies to Treponema pallidum, which helped to distinguish neurosyphilis from glioma. He was initially treated with penicillin injection; however, it caused liver dysfunction and penicillin was switched to erythromycin. Even after antibiotic therapy for 2 months, his dementia did not improve. He underwent brain MRI four times during the treatment course, and they showed steady progression of brain atrophy in the right hemisphere. Taking these findings together, we diagnosed Lissauer form of general paresis. To the best of our knowledge, this is the first case of Lissauer form of paretic neurosyphilis, in which the progression of brain atrophy was clearly demonstrated on MRI.
一名60岁男性出现进行性痴呆和全身性惊厥。最初的MRI显示，在T2加权图像上，右侧额叶和颞叶有广泛的高强度区域并伴有占位效应。数字减影血管造影结果正常。血清和脑脊液检测显示梅毒螺旋体抗体滴度很高，这有助于将神经梅毒与胶质瘤区分开来。他最初接受青霉素注射治疗；然而，这导致了肝功能障碍，于是青霉素换成了红霉素。即使经过2个月的抗生素治疗，他的痴呆症状仍未改善。在治疗过程中，他接受了4次脑部MRI检查，结果显示右半球脑萎缩呈稳定进展。综合这些发现，我们诊断为利绍尔型全身麻痹性痴呆。据我们所知，这是首例利绍尔型麻痹性神经梅毒病例，MRI清晰显示了脑萎缩的进展情况。
