MRI in patients with general paresis

Abstract

Few cases of MRI in neurosyphilis have been reported. We examined the value of MRI in patients with general paresis; MRI was performed on four HIV-negative patients with parenchymatous neurosyphilis. It demonstrated frontal and temporal atrophy, subcortical gliosis and, in one patient, increased ferritin in the basal ganglia. The progression of the lesions on MRI correlated well with the neuropsychiatric disturbances. The MRI findings correlated with the well-known neuropathological findings. This combination of pathological findings in neurosyphilis has not been described before and we suggest that MRI is of prognostic value in patients with general paresis.

Neurocognitive and psychiatric changes as the initial presentation of neurosyphilis

“…We found only one other reported case of a patient with neurosyphilis who had mineral deposition, presumed to be ferritin, in the basal ganglia. 20 Whether mineral deposition in our patient's brain was related to syphilis, was an incidental finding or was due to a second concurrent disorder is unknown. Mineral deposition in the brain has previously been reported in patients with Parkinson disease and other neurodegenerative diseases.…”

“…Mineral deposition in the brain has previously been reported in patients with Parkinson disease and other neurodegenerative diseases. 20 Although there have been a few reported cases of neurosyphilis manifesting with parkinsonism, the incidence is thought to have declined in recent years and remains rare. 13 Because the parkinsonian features in our first patient did not abate or reverse after treatment with penicillin and persisted unchanged over the 4 years after all neuroleptics were stopped, the relative contribution of neurosyphilis and neuroleptics to his parkinsonian features remains unclear.…”

Neurosyphilis Showing Transient Global Amnesia-like Attacks and Magnetic Resonance Imaging Abnormalities Mainly in the Limbic System.

“…However, in a review of the current literature, limbic lesions have not been described in syphilitic meningovasculitis (1,3,4). On the other hand, in genera] paresis, cerebral cortical atrophy and white matter changes have been emphasized (6,7). In only one of 3 cases described b> Zifko et al (7), high signal lesions and marked atrophy were observed in both hippocampi at the chronic stage.…”

Cognitive impairments in common and rare somatic diseases

“…При этом на КТ/МРТ определяется кортикальная цереб-ральная и церебеллярная атрофия с множественными очага-ми, при SPECT -гипоперфузия во фронто-темпоральных областях [61,62]. При нейровизуализационном исследова-нии у пациентов с прогрессивным параличом выявляется церебральная атрофия, а у больных с менинговаскулярным сифилисом, протекающим с картиной мультиинфарктной деменции, -множественные постинсультные очаги [63][64][65][66][67]. Описано небольшое количество случаев, при которых ней-ровизуализационная картина напоминала БА.…”

“…В 1 из 4 случа-ев, представленных U. Zifko и соавт. [63], при МРТ головно-го мозга выявлены двусторонняя атрофия и глиоз гиппокам-пов. Другой пациент [68] имел когнитивные и поведенче-ские симптомы, а при МРТ головного мозга наблюдалась ат-рофия медиальных височных областей, которая соответст-вовала ранним изменениям при БА.…”