背景:梅毒螺旋体可在感染早期侵入中枢神经系统(CNS),导致神经梅毒.神经梅毒通常表现为急性或亚急性期的脑膜血管炎,而背叶和麻痹性痴呆是后期的经典病症。然而,梅毒通常被误诊为其他疾病,如肿瘤或自身免疫性疾病,包括血管炎和脑炎,这就是为什么这种情况被称为“伟大的米克”。“近年来梅毒发病率的增加强调了早期诊断和治疗的重要性;然而,它的多种临床表现给临床医生带来了诊断挑战,因为它类似于其他疾病。在这个系列中,我们通过三种独特的放射学表现提出了神经梅毒的令人印象深刻的表现。
方法:案例1详述了一名HIV阳性男性的视神经受累,MRI和眼底镜检查结果证实梅毒性视神经炎。病例2描述了一名怀孕期间最初在MRI上怀疑听神经瘤的患者,后来被诊断为影响内耳道的梅毒性胶瘤。病例3是一名年轻男性,具有模仿颞动脉炎的临床特征,最终确定为颅骨骨髓炎继发引起颞肌炎和脑膜炎。
结论:这些病例强调了在鉴别诊断中考虑梅毒的必要性,鉴于其临床表现的多样性。放射学在避免不必要的干预方面起着重要作用。复发性梅毒患病率的增加给诊断带来了挑战,强调临床医生早期诊断和治疗神经梅毒的重要性。
BACKGROUND: Treponema pallidum can invade the central nervous system (CNS) early in its infection, causing
neurosyphilis.
Neurosyphilis typically presents with meningovasculitis in the acute or subacute phase, while tabes dorsalis and dementia paralytica are classical conditions in the later stages. However, syphilis is often misdiagnosed as other conditions such as tumors or autoimmune diseases including vasculitis and encephalitis, which is why the condition is known as \"The Great Mimicker.\" The increasing incidence of syphilis in recent years emphasizes the importance of early diagnosis and treatment; however, its multiple clinical manifestations impose diagnostic challenges for clinicians because it resembles other diseases. In this
case series, we present the impressive manifestations of
neurosyphilis through three unique radiological presentations.
METHODS: Case 1 details optic nerve involvement in an HIV-positive male, where MRI and fundoscopic findings confirmed syphilitic optic neuritis.
Case 2 describes a patient in her pregnancy initially suspected of acoustic neuroma on MRI, later diagnosed with syphilitic gumma affecting the inner ear canal.
Case 3 is a young male with clinical features mimicking temporal arteritis, ultimately identified as skull osteomyelitis secondarily causing inflammation of the musculus temporalis and meningitis.
CONCLUSIONS: These cases underscore the necessity of considering syphilis in differential diagnoses, given the diversity of its clinical presentations. Radiology plays an important role in avoiding unnecessary interventions. The increasing prevalence of recurrent syphilis imposes diagnostic challenges, emphasizing the importance of the early diagnosis and treatment of neurosyphilis by clinicians.