Nishina Takuya, Uemori Mami, Satou Tomohiko, Asano Akihiko
Department of Neurology, Nihonseimeisaiseikai Nissay Hospital.
Rinsho Shinkeigaku. 2018 Jun 27;58(6):395-398. doi: 10.5692/clinicalneurol.cn-001063. Epub 2018 Jun 1.
A 52-year-old man presented with progressive dementia and left hemiparesis. He was treated for neurosyphilis at 44 years old in another hospital. An initial MRI revealed a widespread high-intensity area in the right temporal lobe on DWI. Findings on MRA were normal. He was treated initially with intravenous edaravone and glyceol, but neurological finding did not improved. Serological tests of serum and CSF demonstrated high titers of antibodies to Treponema pallidum. He was treated for relapsed neurosyphilis with daily penicillin G injections without improvement. Penicillin G was switched to erythromycin. After administration of erythromycin, neurological symptoms improved and MRI abnormality showed progression. This case could be considered as Lissauer form of general paresis because of left hemiparesis and MRI findings. Neurosyphilis should be considered in a case with revealing high density area in DWI.
一名52岁男性出现进行性痴呆和左侧偏瘫。他44岁时在另一家医院接受过神经梅毒治疗。最初的MRI显示，弥散加权成像（DWI）上右侧颞叶有广泛的高强度区域。磁共振血管造影（MRA）结果正常。他最初接受了依达拉奉和甘油静脉治疗，但神经症状并未改善。血清和脑脊液的血清学检测显示梅毒螺旋体抗体滴度很高。他接受了每日注射青霉素G治疗复发性神经梅毒，但病情没有改善。青霉素G换成了红霉素。使用红霉素后，神经症状改善，MRI异常显示进展。由于左侧偏瘫和MRI表现，该病例可被视为全身性麻痹的利绍尔型。对于DWI显示高密度区域的病例，应考虑神经梅毒。
