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Neurosyphilis in disguise

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Abstract

Purpose

Neurosyphilis can mimic different diseases, not only in its clinical presentation but also on imaging. Treponema pallidum is also known as the “great imitator.” Having an ultimate diagnosis of neurosyphilis is quite critical as this can affect management drastically. Herein, we discuss the case of a 69-year-old female who was treated for neurosyphilis, while having an atypical imaging finding of anterior temporal lobe enhancement that simulated an infection with herpes simplex virus (HSV); we also review the available literature on different imaging findings in both the early and late stages of the disease.

Methods

We performed a literature search using the new PubMed in June 2021. The terms “neurosyphilis”, “MRI”, and “neuroimaging” were used either alone or in combination with “early neurosyphilis” or “late neurosyphilis”. Data on neurosyphilis and imaging findings was mainly derived from review articles, cohort studies, case series, and individual reports.

Conclusion

Neurosyphilis can present with an extensive variation and different patterns on the MRI, and clinicians must be aware of the wide variety in radiological presentations. Anterior temporal lobe involvement is a rare presentation and requires evaluating for neurosyphilis to prevent a missed diagnosis and treatment.

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Availability of data and material

All data is available from the corresponding author upon reasonable request.

Code availability

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Change history

  • 24 October 2021

    The citation shows the author last name as Nour. However, the last name is Aboul Nour. This is now corrected.

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Acknowledgements

The authors thank Karla D. Passalacqua, PhD, at Henry Ford Hospital for editorial services.

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Authors and Affiliations

  1. Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA

    Ammar Jum’ah, Hassan Aboul Nour, Mohammad Alkhoujah & Daniel Miller

  2. Department of Radiology, Hamad Medical Corporation, Doha, Qatar

    Sohaib Zoghoul

  3. Jordan University of Science and Technology, Irbid, Jordan

    Lara Eltous

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  1. Ammar Jum’ah
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  2. Hassan Aboul Nour
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  3. Mohammad Alkhoujah
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  4. Sohaib Zoghoul
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Correspondence to Ammar Jum’ah.

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Jum’ah, A., Aboul Nour, H., Alkhoujah, M. et al. Neurosyphilis in disguise. Neuroradiology 64, 433–441 (2022). https://doi.org/10.1007/s00234-021-02827-3

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