MR findings in neurosyphilis--a literature review with a focus on a practical approach to neuroimaging.

BACKGROUND

Syphilis is a sexually transmitted disease caused by Treponema pallium. The invasion of the central nervous system is observed in 5-10% of untreated patients and may occur at any stage of the disease. The diagnosis of the early stage of syphilitic infection is complex as many patients present either nonspecific symptoms or are asymptomatic. The identification of the most common radiologic characteristics of neurosyphilis is important in the proper diagnosis of the infection.

METHOD: The paper reviews the MR findings in neurosyphilis presented in the literature with the emphasis on common traits, patterns and factors in MR neuroimaging in neurosyphilis.

RESULTS

Twelve papers were selected as suitable for analysis. Psychiatric symptomatology was the most common clinical manifestations of neurosyphilis. As MRI findings in neurosyphilis were not highly specific it proved being the most sensitive technique in detecting the changes in cerebral vasculitis commonly presenting with focal areas of high signal intensity in any distribution with areas of infarction and hemorrhage observed at times. In neurosyphilis medium and small vessels are usually involved. Parenchymal and meningeal enhancement was usually demonstrated. The most frequently involved arteries are middle cerebral artery and branches of the basilar artery. However, normal findings were also common.

CONCLUSIONS

The most common MR diagnostic features are medium contrast enhancement, atrophy, white matter lesions, cerebral infarction, oedema. Radiologists, neurologists, and psychiatrists should take neurosyphilis into consideration when facing the differential diagnosis in central vascuclar disorders.