Clinical,electroencephalographic,and imaging features of neurosyphilis with epileptic seizures
10.19845/j.cnki.zfysjjbzz.2024.0122
- VernacularTitle:神经梅毒伴癫痫发作的临床、脑电图及影像学特征分析
- Author:
Cancan MA
1
;
Xibin ZHANG
;
Jian WU
Author Information
1. 扬州大学附属苏北人民医院神经内科,江苏 扬州 225001
- Keywords:
Epileptic seizure;
Neurosyphi-lis;
Clinical manifestation;
Video electroencephalo-gram;
Magnetic resonance imaging
- From:
Journal of Apoplexy and Nervous Diseases
2024;41(7):631-636
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the characteristics of neurosyphilis with epileptic seizures.Methods We retrospectively analyzed the clinical,laboratory,electroencephalographic,and imaging characteristics of eight patients with neurosyphilis with epileptic seizures treated in the Department of Neurology,Subei People's Hospital,Yangzhou Uni-versity from May 2018 to May 2022.Results There were five males and three females.The time from the first epileptic seizure to admission ranged from one day to six months.Two patients presented with only epileptic seizures,while six and four patients also had cognitive impairment and psychiatric symptoms,respectively.Regarding clinical types,six were parenchymatous neurosyphilis and two were meningovascular neurosyphilis.Seizure types included one case of focal sei-zures,five cases of focal to bilateral tonic-clonic seizures,and two cases of generalized seizures.Video electroencephalog-raphy detected abnormalities in seven cases:background slowing,slow rhythms,epileptiform discharges,and periodic lat-eralized epileptiform discharges(PLEDs);among them,four cases showed PLEDs,and one showed focal fast activity be-ginning in the left temporal lobe.All the eight patients were positive for serum and cerebrospinal fluid(CSF)Treponema pallidum particle agglutination test and the toluidine red unheated serum test(TRUST);and six were positive for CSF TRUST/the rapid plasma reagin test,while two were negative for CSF TRUST.CSF testing showed elevated pressure levels in four cases,elevated protein levels in four cases,and elevated leukocyte counts in six cases.Cranial magnetic resonance imaging findings of the eight patients showed abnormal signals predominantly in the temporal lobe,cerebral atrophy,hydro-cephalus,and ischemic infarcts or white matter lesions.Arterial spin labeling of five patients revealed hyperperfusion in three patients and hypoperfusion in two patients.The patients were treated with penicillin or ceftriaxone as well as antiepi-leptic drugs and symptomatic treatment,achieving good prognoses in six cases but poor outcomes in two cases.Conclusion For patients with epilepsy accompanied by cognitive impairment and mental disorders,we should be alert to the possibility of neurosyphilis after excluding other neurological diseases.Electroencephalography and imaging examinations can help assess the severity and prognosis of neurosyphi-lis,and early active treatment can improve outcome.
