Xu Lingmei, Han Fugang
Department of Radiology, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, Sichuan, China.
Medicine (Baltimore). 2019 Nov;98(45):e17770. doi: 10.1097/MD.0000000000017770.
Neurosyphilis is a chronic, infectious disease of the central nervous system. Pial arteriovenous fistulae (PAVF) are rare vascular malformations. Both can cause vascular damage, but it is quite rare for both to present at the same time.
Here we present a 66-year-old man with affective disorder, hypomnesia, and recent convulsions. Magnetic resonance imaging revealed cerebral swelling, hyperintensity in the cortex/subcortex, and multiple lacunar cerebral infarctions. Computed tomography angiography revealed the presence of a pial arteriovenous fistula.
Based on laboratory tests and imaging, diagnoses of neurosyphilis and pial arteriovenous fistula were made.
Antisyphilis therapy was provided.
Symptoms improved and antisyphilis treatment continued as an outpatient. No intracranial hemorrhage was seen 6 months later.
Treponema pallidum infection may be related to the formation of PAVF, and may also promote the progression of it; however, further work is required to confirm this.
神经梅毒是一种中枢神经系统的慢性感染性疾病。软脑膜动静脉瘘（PAVF）是罕见的血管畸形。两者均可导致血管损伤，但两者同时出现的情况相当罕见。
我们在此报告一名66岁男性，患有情感障碍、记忆力减退和近期惊厥。磁共振成像显示脑肿胀、皮质/皮质下高信号以及多发腔隙性脑梗死。计算机断层血管造影显示存在软脑膜动静脉瘘。
根据实验室检查和影像学检查，诊断为神经梅毒和软脑膜动静脉瘘。
给予抗梅毒治疗。
症状改善，抗梅毒治疗作为门诊治疗持续进行。6个月后未见颅内出血。
梅毒螺旋体感染可能与软脑膜动静脉瘘的形成有关，也可能促进其进展；然而，需要进一步研究来证实这一点。
