Imaging features of neurosyphilis

• Published in: Journal of neuroradiology 2023-03, Vol.50 (2), p.241-252
• Main Authors: Corrêa, Diogo Goulart, de Souza, Simone Rachid, Freddi, Tomás de Andrade Lourenção, Fonseca, Ana Paula Alves, dos Santos, Roberto Queiroz, Hygino da Cruz Jr, Luiz Celso
• Format: Article
• Language: English
• Subjects: Child; Female; Gumma; Homosexuality, Male; Humans; Infectious Disease Transmission, Vertical; Male; Meningitis; Meningovascular syphilis; Neuroimaging; Neurosyphilis; Neurosyphilis - cerebrospinal fluid; Neurosyphilis - diagnosis; Neurosyphilis - drug therapy; Sexual and Gender Minorities; Syndrome; Syphilis
• ISSN: 0150-9861
• DOI: 10.1016/j.neurad.2023.01.003

•Neurosyphilis can appear at any time during the infection.•Symptomatic neurosyphilis can be characterized by several main syndromes.•HIV+ patients present increased risk for the development of neurosyphilis.•Meningitis, stroke, encephalitis, myelitis and tabes dorsalis are possible syndromes.•Meningovascular syphilis is currently the most common form of neurosyphilis. Syphilis is an infectious disease caused by the spirochete Treponema pallidum, subspecies pallidum. Although its incidence has declined after the widespread availability of penicillin, it has recently re-emerged, especially in men who have sex with men and in people living with human immunodeficiency virus (HIV). The neurological manifestations of syphilis, generally known as neurosyphilis, may appear at any time during the infection, including the initial years after the primary infection. Neurosyphilis can be asymptomatic, only with cerebrospinal fluid abnormalities, or symptomatic, characterized by several different clinical syndromes, such as meningitis, gumma, meningovascular, brain parenchyma involvement, meningomyelitis, tabes dorsalis, and peripheral nervous system involvement. However, these syndromes may simulate several other diseases, making the diagnosis often a challenge. In addition, syphilis can also be vertically transmitted from mother to child during pregnancy, leading to neurological manifestations. Neuroimaging is essential to demonstrate abnormal brain or spinal cord findings in patients with neurosyphilis, aiding in the diagnosis, treatment, and follow-up of these patients. This article aims to review the imaging features of neurosyphilis, including the early and late stages of the infection.