Neurosyphilis in HIV-positive and HIV-negative patients

Neuroimaging findings

T. C. Brightbill, I. H. Ihmeidan, M. Judith Post, J. R. Berger, D. A. Katz

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To evaluate and describe the neuroimaging findings of patients with neurosyphilis. METHODS: The neuroimaging studies of 35 patients with documented neurosyphilis were reviewed. Diagnosis was established in 34 patients with cerebrospinal fluid for a Venereal Disease Research Laboratory test, complemented by autopsy in 1 and brain biopsy in 1. All patients had reactive fluorescent treponemal antibody tests with absorption in their sera. Imaging studies included plain and contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, MR angiography, and conventional angiography. Imaging findings were also correlated with the relevant pathologic findings at autopsy in three additional patients with neurosyphilis who did not have brain imaging studies. RESULTS: Of the 35 patients with imaging studies, 32 tested human immunodeficiency virus (HIV)-seropositive, and 3 were HV- seronegative. Eleven (31%) of 35 patients had normal radiographic findings. Cerebral infarctions were seen in 8 (23%) of 35 patients, and nonspecific white matter lesions in 7 (20%) of 35. Cerebral gummas and extraaxial enhancement indicating meningitis were noted in 2 (6%) of 35 patients, respectively. Arteritis was demonstrated in 2 (50%) of 4 patients who underwent either MR angiography or conventional angiography. The 3 subjects who had autopsy but not imaging studies were found to have manifestations of meningovascular syphilis, including syphilitic leptomeningitis and an obliterative endarteritis. CONCLUSION: We conclude that findings of vascular occlusive disease manifested as infarction or arteritis, enhancing cortical lesions with or without adjacent meningeal enhancement, focal or diffuse extraaxial enhancement, and white matter disease, although nonspecific, in the proper clinical setting should prompt appropriate testing for neurosyphilis, a treatable disease, in patients with and without HIV infection.

Original languageEnglish
Pages (from-to)703-711
Number of pages9
JournalAmerican Journal of Neuroradiology
Volume16
Issue number4
StatePublished - Jan 1 1995

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Neurosyphilis
Neuroimaging
HIV
Angiography
Autopsy
Arteritis
Fluorescent Treponemal Antibody-Absorption Test
Endarteritis
Leukoencephalopathies
Cerebral Infarction
Gadolinium
Brain
Virus Diseases
Syphilis
Sexually Transmitted Diseases
Vascular Diseases
Meningitis
Infarction
Cerebrospinal Fluid

Keywords

  • Acquired immunodeficiency syndrome (AIDS)
  • Syphilis

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Brightbill, T. C., Ihmeidan, I. H., Judith Post, M., Berger, J. R., & Katz, D. A. (1995). Neurosyphilis in HIV-positive and HIV-negative patients: Neuroimaging findings. American Journal of Neuroradiology, 16(4), 703-711.

Neurosyphilis in HIV-positive and HIV-negative patients : Neuroimaging findings. / Brightbill, T. C.; Ihmeidan, I. H.; Judith Post, M.; Berger, J. R.; Katz, D. A.

In: American Journal of Neuroradiology, Vol. 16, No. 4, 01.01.1995, p. 703-711.

Research output: Contribution to journalArticle

Brightbill, TC, Ihmeidan, IH, Judith Post, M, Berger, JR & Katz, DA 1995, 'Neurosyphilis in HIV-positive and HIV-negative patients: Neuroimaging findings', American Journal of Neuroradiology, vol. 16, no. 4, pp. 703-711.
Brightbill TC, Ihmeidan IH, Judith Post M, Berger JR, Katz DA. Neurosyphilis in HIV-positive and HIV-negative patients: Neuroimaging findings. American Journal of Neuroradiology. 1995 Jan 1;16(4):703-711.
Brightbill, T. C. ; Ihmeidan, I. H. ; Judith Post, M. ; Berger, J. R. ; Katz, D. A. / Neurosyphilis in HIV-positive and HIV-negative patients : Neuroimaging findings. In: American Journal of Neuroradiology. 1995 ; Vol. 16, No. 4. pp. 703-711.
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