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Neurology Resident and Fellow Section

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Presentation on theme: "Neurology Resident and Fellow Section"— Presentation transcript:

1 Neurology Resident and Fellow Section
A 62-year-old man with chronic headache. Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

2 Vignette A 62-year-old HIV-negative man without any past history had extramarital sex once 3 years before admission. A malignant-tumor-like-lesion was found on brain MRI when he came to our clinic with chronic headache. Kuroi Y et al. © 2017 American Academy of Neurology

3 Brain MRI A B Kuroi Y et al.
(A) Axial enhanced T1-weighted image and (B) FLAIR image revealed ring enhanced lesion with significant edema at the right temporal lobe. (C) FLAIR image taken three months after total tumor removal and postoperative antibacterial therapy (PCG 6,000,000 U/day for 14 days and AMPC 4000 mg/day for 14 days). A B Kuroi Y et al. © 2017 American Academy of Neurology

4 Imaging Pathological images. (A) Immunostaining using anti-Treponema pallidum antibody demonstrated numerous perivascular spirochetes (original magnification x40). (B, C) Hematoxylin-eosin staining revealed “gumma” composed of granulation tissue and massive necrosis accompanied by marked inflammatory cell infiltration, and meningitis with numerous lymphoplasmacytes accompanied by some occluded vessels (original magnification B; x2.5, C; x4 respectively). Kuroi Y et al. © 2017 American Academy of Neurology

5 “Cerebral syphilitic gumma” with numerous spirochetes in immunohistochemical staining
Postoperative antibacterial agent therapy significantly diminished the edematous lesion. The initial fold higher serum-RPR, fold higher TPHA, 1280-fold higher FTA-ABS, and 2.2-fold higher CSF-RPR levels gradually decreased over six months. Cerebral syphilitic gumma usually occurs >10 years after contracting syphilis1. Although It is difficult to detect single spirochetes with immunohistochemical staining2, aggressive cases may exhibit many spirochetes. References. 1. Clark EG, Danbolt N. The Oslo study of the natural history of untreated syphilis; an epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material; a review and appraisal. J Chronic Dis. 1955; 2: 2. Zhang L, Zhou Y, Chen J, Yan W, Kong Q, Chen P, Sang H. A case of a cerebral syphilitic gumma developed in a few months mimicking a brain tumor in a human immunodeficiency virus-negative patient. Br J Neurosurg Epub 2016 Apr 18. Kuroi Y et al. © 2017 American Academy of Neurology

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