Neurosyphilitic gummas:A case report and literature review

YANG Nan; LI Wei

doi:10.19300/j.2018.L6088

Abstract：Objective To investigate the radiolographic features and differential diagnosis of neurosyphilitic gum-mas.Methods The imaging data of one patient with neurosyphilitic gummas were analyzed,and the relevant literature were reviewed.Results The initial plain head CT scan showed a patch-shaped hypodense lesion inpons.The unenhanced MR imaging revealed the lesion had hypointensity on T1-weighted image and hyperintensity on T2-weighted image.The patient was suspected of ischemic infarct.The first follow-up MRI examination displayed the margin of the lesion became well-delin-eated,indicating encephalomalacia.However,there was another large patch-shaped high T2signal intensity lesion in pons,midbrain and brachium pontis bilaterally.The second follow-up MRI examination showed the high T2signal intensity lesion became smaller than before,and the ventral pontine part of the lesion demonstrated spot-like and heterogenous enhancement after contrast administration.MR angiography manifested the lumen of basilar artery apex was of different diameter.After an-tisyphilitic treatment,the improvement was noted on the brain MRI,which showed the abnormal enhanced lesion was of com-pletely resolution and only encephalomalacic areas in the pons was remained.The final diagnosis of neurosyphilis,syphilitic gumma with perivasculitis,and secondary brainstem infarction and encephalomalacia was made based on the combination of the patient's medical history,the dynamic evolution process and therapeutic effect.Conclusions The radiographic features of syphilitic gummas are lack of specificity,and the rate of preoperative misdiagnosis is high.Combination of clinical history,laboratory test,imaging features,and experimental treatment for suspected cases is helpful to avoid unnecessary invasive in-tracranial operation.