Meningovascular and Spinal form of Neurosyphilis Presenting as Multiple Cranial Nerve Palsy, Cerebral Infarction and Meningomyelitis in a Human Immunodeficiency Virus Negative-Patient: MR Imaging Features

Syphilis is a sexually transmitted disease caused by a spirochete, Treponema pallidum (T. pallidum). Involvement of the central nervous system (CNS) occurs in 5-30% of the patients and the CNS may be affected at any stage of the disease (1). It is difficult to differentiate neurosyphilis from other cerebral infectious and inflammatory diseases, because of its various times of onset and diverse form of presentation. Major forms of neurosyphilis include asymptomatic, acute syphilitic meningitis, meningovascular syphilitis, parenchymal and gummatous neurosyphilis (2). A reactive cerebrospinal fluid (CSF) venereal disease research laboratories (VDRL) at any stage of syphilis is required for confirmation of neurosyphilis; however, the test is negative in approximately half of the patients and the sensitivity of CSF VDRL is relatively low (3). Therefore, magnetic resonance imaging (MRI) may help to make an earlier diagnosis of neurosyphilis in a patient with syphilis and neurologic symptoms. Neuroradiological findings regarding neurosyphilis, particularly MR imaging, are varied and CNS abnormalities are nonspecific edematous or enhancing INTRODUCTION