Neurosyphilis: mighty imitator forays with benign presentation and unique neuroimaging findings

Sexual Health ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 358 ◽  
Author(s):  
Harmanpreet Tiwana ◽  
Aiesha Ahmed
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Treponema Pallidum ◽  
White Matter Lesions ◽  
Vascular Pathology ◽  
Cortical Atrophy ◽  
Neck Stiffness ◽  
Fluid Attenuated Inversion Recovery

Background Common causes of temporal lobe hyper intensities are central nervous system infections like herpes simplex encephalitis, Lyme disease, limbic encephalitis and vascular pathology like Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy. Methods: Personal assessment, laboratory data analysis and neuroimaging for the patient who was admitted to a central Pennsylvania tertiary care referral centre were conducted. Results: A 52-year-old male presented with a 1-year history of diffuse dysesthesia in upper and lower extremities with associated intermittent headaches and neck stiffness. Evaluation with lumbar puncture revealed increased nucleated cells (50 ul) with lymphocytic predominance (96%) and an elevated protein level of 109 mg/dl. Magnetic resonance imaging (MRI) of the brain showed T2/FLAIR hyper intensity in bilateral subcortical temporal white matter, left-greater-than-right and associated volume loss in cerebral parenchyma. Additional abnormal work up included reactive serum reactive plasma regain and Treponema pallidum antibody particle agglutination. Diagnosis of neurosyphilis was made and the patient was treated with intramuscular (IM) penicillin for 3 weeks. At the time of discharge, his headache and neck stiffness resolved and dysesthesias were decreased in intensity. Conclusions: The diagnosis of neurosyphilis is intricate, and no reference standard exists. Neuroimaging findings of neurosyphilis commonly are cerebral infarctions, leptomeningeal enhancement or non-specific white matter lesions. Less common features on fluid-attenuated inversion recovery (FLAIR) sequences are cortical atrophy and mesial temporal parenchymal signal changes. It is prudent to keep neurosyphilis in differential of mesial temporal lobe white matter changes, as early diagnosis and treatment results in better prognosis.

scholarly journals Characteristics of Cortical Atrophy and White Matter Lesions Between Dementia With Lewy Bodies and Alzheimer's Disease: A Case-Control Study

2022 ◽  
Vol 12 ◽  
Author(s):  
Han Zhu ◽  
Hao Lu ◽  
Fei Wang ◽  
Shuai Liu ◽  
Zhihong Shi ◽  
...  
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Dementia With Lewy Bodies ◽  
Rating Scales ◽  
Lewy Bodies ◽  
White Matter Lesions ◽  
Cortical Atrophy ◽  
Visual Rating ◽  
Normal Controls

Introduction: Currently, there is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB. For better diagnosis and prognosis, further exploration of local cortical atrophy patterns and white matter lesions is needed.Methods: We reviewed the outpatient medical records of 97 DLB patients and 173 AD patients from January 2018 to September 2020 along with 30 matched outpatient clinic normal elderly people. MRI visual rating scales, including medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale (GCA-F), posterior atrophy (PA), Fazekas scale, Evans Index and cerebral microbleeds were evaluated and analyzed in DLB and AD patients with different severities and normal controls.Results: Overall, patients with DLB had higher scores on all visual rating scales than the normal controls. Meanwhile, compared with AD, DLB had lower MTA scores in the mild to moderate groups (both p ≤ 0.001), but the GCA-F and PA scores were similar (all p > 0.05). The Fazekas scores in the moderate to severe DLB group were lower than those in the AD group (p = 0.024 and p = 0.027, respectively). In addition, the diagnostic performance and sensitivity of multiple imaging indicators for DLB were better than that of MTA alone (the combination of MTA, GCA-F, PA, Fazekas visual rating scales, AUC = 0.756, 95%CI: 0.700–0.813, sensitivity = 0.647, specificity = 0.804 and MTA visual rating scale, AUC = 0.726, 95%CI: 0.667–0.785, sensitivity = 0.497, specificity = 0.876, respectively).Conclusion: The medial temporal lobe of DLB patients was relatively preserved, the frontal and parietal lobes were similarly atrophied to AD patients, and the white matter hyperintensity was lighter than that in AD patients. Combined multiple visual rating scales may provide a novel idea for the diagnosis of early DLB.

scholarly journals Multiple Factors Involved in the Pathogenesis of White Matter Lesions

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Jing Lin ◽  
Dilong Wang ◽  
Linfang Lan ◽  
Yuhua Fan
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
White Matter ◽  
Genetic Factors ◽  
Subsequent Development ◽  
White Matter Lesions ◽  
Blood Brain Barrier Disruption ◽  
Fluid Attenuated Inversion Recovery ◽  
Cerebral Blood Flow Autoregulation ◽  
Brain Barrier Disruption

White matter lesions (WMLs), also known as leukoaraiosis (LA) or white matter hyperintensities (WMHs), are characterized mainly by hyperintensities on T2-weighted or fluid-attenuated inversion recovery (FLAIR) images. With the aging of the population and the development of imaging technology, the morbidity and diagnostic rates of WMLs are increasing annually. WMLs are not a benign process. They clinically manifest as cognitive decline and the subsequent development of dementia. Although WMLs are important, their pathogenesis is still unclear. This review elaborates on the advances in the understanding of the pathogenesis of WMLs, focusing on anatomy, cerebral blood flow autoregulation, venous collagenosis, blood brain barrier disruption, and genetic factors. In particular, the attribution of WMLs to chronic ischemia secondary to venous collagenosis and cerebral blood flow autoregulation disruption seems reasonable. With the development of gene technology, the effect of genetic factors on the pathogenesis of WMLs is gaining gradual attention.

Association between blood pressure, white matter lesions, and atrophy of the medial temporal lobe

Neurology ◽  
2005 ◽  
Vol 64 (2) ◽  
pp. 263-267 ◽  
Author(s):  
T. den Heijer ◽  
L. J. Launer ◽  
N. D. Prins ◽  
E. J. van Dijk ◽  
S. E. Vermeer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
White Matter Lesions

Age Dependent White Matter Lesions and Brain Volume Changes in Healthy Volunteers

1994 ◽  
Vol 35 (2) ◽  
pp. 117-122 ◽  
Author(s):  
P. Christiansen ◽  
H. B. W. Larsson ◽  
C. Thomsen ◽  
S. B. Wieslander ◽  
O. Henriksen
Keyword(s):  
White Matter ◽  
Healthy Volunteers ◽  
White Matter Lesions ◽  
Linear Increase ◽  
Cerebral Hemispheres ◽  
Cortical Atrophy ◽  
White Matter Hyperintensity ◽  
Lateral Ventricles ◽  
Males And Females ◽  
Hyperintensity Lesions

The brain of 142 healthy volunteers aged 21 to 80 years were investigated using MR imaging. The number and size of the white matter hyperintensity lesions (WMHL) in the cerebral hemispheres were determined. Furthermore, the volume of the cerebral hemispheres and of the lateral ventricles was measured. An almost linear increase in the number of volunteers with WMHL was seen with aging for males and females. With aging a significant decrease in the volume of the cerebral hemispheres was found for males, and a significant increase in the volume of the lateral ventricles was seen for both males and females. Our results suggest that with aging central atrophy increases more (relatively) than cortical atrophy. No correlation was found between the decreasing volume of the cerebral hemispheres and the increasing number and size of WMHL, nor between the increasing volume of the lateral ventricles and the increasing number and size of WMHL.

O1-02-02 White matter lesions are associated with cortical atrophy more than entorhinal and hippocampal atrophy

2004 ◽  
Vol 25 ◽  
pp. S11
Author(s):  
Antao Du ◽  
Norbert Schuff ◽  
Linda L. Chao ◽  
John Kornak ◽  
Frank Ezekiel ◽  
...  
Keyword(s):  
White Matter ◽  
White Matter Lesions ◽  
Cortical Atrophy ◽  
Hippocampal Atrophy

Clinical and Neuroimaging Changes of Subacute Sclerosing Panencephalitis – Experience 30 Cases in Tertiary Care Center in Bangladesh

2021 ◽  
Vol 2 (3) ◽  
pp. 1-4
Author(s):  
Gopen Kumar Kundu ◽  
Mohammad Monir Hossain
Keyword(s):  
Early Childhood ◽  
White Matter ◽  
Subacute Sclerosing Panencephalitis ◽  
Tertiary Care ◽  
Stage Ii ◽  
Cortical Atrophy ◽  
Periventricular White Matter ◽  
History Of ◽  
Signal Changes ◽  
Intense Signal

Background: Subacute sclersing panencephalitis (SSPE) is a very rare progressive, fatal neurodegenerative disease of the control nervous system of childhood and early adolescence. It is a slow virus disease caused by persistent defective measles virus infection of the brain Objective: To see the clinical andneuro-imaging findings in children with Subacute sclerosing panencephalitis. Methods: This retrospective study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, a tertiary care premier Postgraduate Medical Institution in Bangladesh. Thirty (30) Subacute sclerosing panencephalitis (SSPE) children were evaluated at paediatric neurology ward during the period January 2010 to December 2017. Diagnosis was based on typical clinical characteristic features, the presence of periodic discharges on EEG, demonstration of raised antibody titer against measles in the plasma and cerebrospinal fluid Detected by ELISA in all patients. Results: Total number of studied children were 30. Mean age was 10.2±3.1 year and Male female ratio was 5:1. Most of the patient arrived from poor socio-economic (83.33%) background of rural area (66.67%) of Bangladesh. Among them 46.67% had history of measles infection during early childhood. Progressive deterioration of school performance (50%), gait disturbance (70%), myoclonus (83%) dysarthria (43%) and Ocular manifestations like optic atrophy & papilledema (83.33%) were the main presenting feature of our studied children. All of the patients (100%) showed positive measles specific antibody IgG in CSF and On electroencephalographic findings showed periodic burst suppression in 90.90% cases. Most of the children (56.6%) were in stage II category and other 3.3%, 33.3%,6.6%, were stage I, stage III, stage IV category respectively. Neuroimaging study showed abnormalities in 45.83% cases included periventricular white matter hyper intense signal changes, cortical atrophy and ischaemic change. Conclusion: In our study most of the SSPE patient were in stage II.About half of the patient had history of measles infection during early childhood. Neuroimaging abnormalities found in about half of the cases and majority cases were in stage II. Common neuroimaging abnormalities were periventricular white matter hyper intense signal changes and cortical atrophy.

scholarly journals Magnetic resonance imaging abnormalities in young euthymic patients with bipolar affective disorder

2006 ◽  
Vol 189 (1) ◽  
pp. 81-82 ◽  
Author(s):  
Selim M. El-Badri ◽  
David A. Cousins ◽  
Sean Parker ◽  
Heather C. Ashton ◽  
Victor L. McAllister ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bipolar Disorder ◽  
White Matter ◽  
Magnetic Resonance ◽  
Temporal Lobe ◽  
Bipolar Affective Disorder ◽  
White Matter Lesions ◽  
Resonance Imaging ◽  
Deep White Matter ◽  
Mri Scans

SummaryTemporal lobe and limbic structures may be abnormal in bipolar disorder. T2-weighted magnetic resonance imaging (MRI) scans frequently show deep white matter lesions. MRI was performed on 50 young (19–39 years) euthymic patients with bipolar disorder and 26 controls. Mean temporal lobe volumes were reduced in patients (right, 9.42 cm3; left, 6.33 cm3) but this could not be ascribed to a specific structure. Deep white matter lesions were present in 5 patients but no controls raising questions of their aetiological significance.

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