Diagnosis and Treatment of Cerebral Syphilitic Gumma: A Report of Three Cases

Shao, Xiaoqiu; Qiang, Di; Liu, Yinhua; Yuan, Quan; Jin, Tao; Bi-hua, JI

doi:10.3389/fnins.2018.00100

Cited by 16 publications

(13 citation statements)

References 18 publications

(15 reference statements)

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“…In most cases the lesions were multiple, with irregular enhancement and mild surrounding edema. 2,8 In our case there was a large area of edema around the lesion, which caused a space-occupying effect. The lesion showed uncommon ring enhancement, which is rarely reported in the literature.…”

Section: Discussionmentioning

confidence: 55%

“…5 It has been established in the literature that syphilitic gumma could apparently be absorbed or could disappear after penicillin treatment. 2,8 Therefore, patients with cerebral syphilitic gumma can receive this diagnostic treatment to avoid unnecessary craniotomy. Penicillin treatment efficacy is measured indirectly by using serology, and a cure is usually defined as reversion to a negative serum status or a 4-fold reduction in the titer from an NTT.…”

Section: Fig 2 Histopathological Examination Showed a Large Quantitmentioning

confidence: 99%

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Cerebral syphilitic gumma masquerading as cerebral metastatic tumors: case report

Weng

Huang

Jiang

et al. 2019

Neurosurgical Focus

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A 45-year-old man was admitted with severe headache and left-sided weakness, which worsened over 1 week. Brain imaging revealed a small lesion close to the sagittal sinus in the right frontal lobe with severe perilesional edema and showed enhancement on both CT and MRI obtained with contrast. Serological findings were positive for toluidine red unheated serum test (TRUST) positivity and Treponema pallidum particle agglutination assay. The patient was first suspected of having a malignant brain tumor and subsequently received emergency craniotomy. Brain biopsy suggested a diagnosis of syphilitic cerebral gumma; meanwhile the postoperative CSF TRUST titer was positive, and the patient’s improvement with high-dose intravenous aqueous crystalline penicillin further supported this etiology. Finally, the lesion on the right frontal lobe had disappeared during the follow-up imaging examination and the myodynamia of the left limbs gradually improved. The authors recommend that diagnostic penicillin treatment should be first implemented. When a patient’s history, clinical manifestations, syphilis serology, CSF examination, and other physiological changes indicate a diagnosis of syphilitic cerebral gumma, there is no doubt that surgery should be performed in patients with acute intracranial hypertension, but unnecessary craniotomy should be avoided as far as possible.

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Section: Discussionmentioning

confidence: 55%

Section: Fig 2 Histopathological Examination Showed a Large Quantitmentioning

confidence: 99%

Cerebral syphilitic gumma masquerading as cerebral metastatic tumors: case report

Weng

Huang

Jiang

et al. 2019

Neurosurgical Focus

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“…Involvement of the brain parenchyma can manifest as brain atrophy, brain swelling, cerebral infarction, white matter lesions, [4] and cerebral syphilitic gumma. [5] This case presented with cerebral infarction, brain swelling, multiple cortical/subcortical regions of band-like hyperintensity, increased perfusion of the right hemisphere, and PAVF. Each of these findings could have arisen from another source; however, these were deemed unlikely because of a positive hemagglutination assay, confirming syphilis infection.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis complicated with pial arteriovenous fistula

Han

2019

Medicine

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Introduction: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.Patient concerns: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.Diagnoses:Based on laboratory tests and imaging, diagnoses of neurosyphilis and pial arteriovenous fistula were made.Interventions:Antisyphilis therapy was provided.Outcomes:Symptoms improved and antisyphilis treatment continued as an outpatient. No intracranial hemorrhage was seen 6 months later.Conclusion: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.

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“…These can cause hydrocephalus or seizures, or may be incidental findings on brain imaging. 30,[63][64][65] The largest case series to date reported that 61.9% (13/21) of patients with CNS gummas who underwent lumbar puncture had a reactive CSF-VDRL. 63 Dementia paralytica presents as progressive dementia manifested as impaired memory and judgement followed by progressive disorientation, confusion, and occasional seizures.…”

Section: Clinicalmentioning

confidence: 99%

Neurosyphilis

2019

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Neurosyphilis is caused by the bacterium Treponema pallidum subspecies pallidum (T. pallidum). The organism gains entry into the central nervous system (CNS) early (primary syphilis or chancre phase) in the course of infection. While most patients are able to mount an immune response that effectively clears CNS invasion without long-term complications, a minority go on to develop asymptomatic or symptomatic neurosyphilis. Neurosyphilis has been divided into early and late stages. The early stages include asymptomatic meningitis, symptomatic meningitis, gumma, and meningovascular syphilis, while the late stages include dementia paralytica and tabes dorsalis. Ocular and otologic syphilis can occur at any time but often accompany the acute meningitis of early neurosyphilis. The diagnosis of symptomatic neurosyphilis requires meeting clinical, serologic, and cerebrospinal fluid (CSF) criteria, while the diagnosis of asymptomatic neurosyphilis relies on serologic and CSF criteria alone. In the last several decades, a persistent rise in syphilitic meningitis and other forms of early neurosyphilis have been seen in the human immunodeficiency virus-positive population, principally in men who have sex with men. This article reviews the clinical presentation, diagnosis, and treatment of neurosyphilis, and it addresses the controversy regarding the role of lumbar puncture early in the course of infection.

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Diagnosis and Treatment of Cerebral Syphilitic Gumma: A Report of Three Cases

Cited by 16 publications

References 18 publications

Cerebral syphilitic gumma masquerading as cerebral metastatic tumors: case report

Cerebral syphilitic gumma masquerading as cerebral metastatic tumors: case report

Neurosyphilis complicated with pial arteriovenous fistula

Neurosyphilis

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