Page 18 - Read Online

fluid-attenuated inversion recovery (FLAIR) pulse syphilitic retrobulbar neuritis), syphilitic gumma, or
sequences, often reveals ribbon-like lesions along the acute inflammatory polyradiculoneuritis. Polyparesis
cerebral cortex lesions, which is a very characteristic usually occurs in patients aged 35–45 years with a long
feature [Figure 2a and b]. However, at the late stage, incubation of between several years and 20 years. With
brain atrophy and ventricular dilatation in patients is the insidious onset, the main symptom of polyparesis is
extremely severe, and ribbon-like lesions are no longer progressive memory loss, which is easily misdiagnosed
evident [Figure 2c and d]. White blood cells may also as Alzheimer’s disease. At the early stage, polyparesis
become visible in the CSF of the CJD patients. For patients experience personality changes, anxiety, and
instance, a virus or other infectious encephalitis cannot emotional volatility, which can easily be misdiagnosed
be confirmed until 10–30 white blood cells are found as depression.
in the CSF. Until date, there has been no case in which
the disease has been transmitted between patients, their In most cases, syphilitic antibody is the positive in
family members and medical staff in China. serum, the white blood cells in the CSF are moderately
elevated, and the protein level is also slightly increased,
DIAGNOSIS OF CENTRAL NERVOUS SYSTEM but a toluidine red unheated serum test and T. pallidum
SYPHILIS INFECTION particle agglutination assay test can reveal normal results
in a few cases. Imaging observations reveal brain atrophy,
Recently, the incidence of syphilis – a disease caused mainly in the hippocampus of the temporal lobe, and
[7]
by infection with Treponema pallidum – has escalated, ventriculomegaly. There is a difference in antisyphilitic
with an increase in the incidence of syphilis infection treatment between polyparesis and general syphilis. For
of the CNS. Nervous system syphilis can be classified polyparesis patients, treatment duration time is 6 months
as, for example, asymptomatic neurosyphilis, to 1 year, sometimes even longer, which is longer than that
syphilitic meningitis or myelomeningitis, syphilitic for general syphilis patients. Improvement in symptoms
brain or spinal cord vasculitis, syphilis of the brain varies considerably between patients depending on when
parenchyma (including polyparesis, tabes dorsalis and the disease is first diagnosed.
Besides the infections described above, there are other
CNS infections with typical clinical characteristics,
such as human immunodeficiency virus, Brinell
bacillus infection, Whipple’s disease, Guangzhou
Angiostrongylus disease, and malaria. Such diseases
can be diagnosed by the application of appropriate tests.
It should be noted that, alongside the development in
clinical practice, clinical viewpoints vary. For example,
we used to think that parasitic infection in the brain
would cause an increase in the eosinophil count in the
a b CSF, but actually, in most parasitic infections of the
brain, the eosinophil count does not increase (except
for Guangzhou Angiostrongylus disease), and the
eosinophil count in the peripheral blood was not
elevated or even mildly elevated. A diagnosis of either
eosinophilia or Churg–Strauss syndrome should be
considered for patients with an elevated eosinophil
count in their peripheral blood and fever. Diagnoses
should be made with caution for patients with viral
meningitis and no identified pathogen, but with normal
electroencephalography, brain MRI scan and CSF, with
c d reference to the patient’s medical history and a careful
Figure 2: (a and b) MRI representations of a sporadic Creutzfeldt–Jakob disease consideration of the neurological examination, rather
patient: high signal on both fluid-attenuated inversion recovery image and than reaching a conclusion based on only the results
diffusion-weighted imaging (DWI) (2009–6–16). (c and d) T2–weighted image of a laboratory examination. Attention should also be
and DWI image of the same patient in a persistent vegetative state (2011–7–13):
serious encephalatrophy with an obvious increase in ventricular volume paid to the differential diagnosis of immune-mediated

Neuroimmunol Neuroinflammation | Volume 1 | Issue 1 | June 2014 11