ORIGINAL RESEARCH article
Front. Neurol.
Sec. Applied Neuroimaging
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1655101
This article is part of the Research TopicNew Insights in Neuroimaging: Highlights from the 42nd Annual Meeting of the Australasian Neuroscience Society (Perth, Western Australia)View all articles
Clinical and imaging findings of neurosyphilis
Provisionally accepted- 1Guangdong 999 Brain Hospital, Guangzhou, China
- 2No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
- 3First Affiliated Hospital of Kunming Medical University, Kunming, China
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Background: This study aimed to systematically analyze the clinical and MRI characteristics of four types of neurosyphilis to improve diagnostic accuracy and facilitate early treatment. By deepening the understanding of clinical presentations and MRI findings, this study seeks to enhance differential diagnosis capabilities. Methods:This was a retrospective study analyzing clinical and MRI data from 23 patients diagnosed with neurosyphilis between January 2016 and May 2024. MRI examinations were performed using 3-Tesla scanners (Siemens, Germany; General Electric, USA) with an 8-channel head coil. The imaging protocol included T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging (T1WI-CE) using gadolinium-based contrast agents. Results: Of the 23 cases of neurosyphilis, including 19 males and 4 females, the mean age was 49.2 ± 11.4 years (range: 27 to 67). 16 cases of parenchymal type (69.6%), mainly manifested as progressive cognitive impairment with psycho-behavioral abnormalities. MRI mainly showed bilateral temporal lobe and hippocampal atrophy with signal abnormalities, with or without abnormal signals in other brain parenchyma, and the enhancement patterns were diverse, which may be unenhanced, patchy, or strip enhancement. 3 cases of meningovascular type (13.0%), presented with ischemic stroke with short duration and acute onset. MRI mainly showed multiple acute cerebral infarcts with extensive but scattered intracranial lesions. 3 cases of syphilis gumma type (13.0%), had a long course of disease and mainly presented with headache. MRI mainly showed multiple lesions in the internal cerebral convexity with significant surrounding edema bands and significant enhancement of the enhanced lesions with adjacent meningeal enhancement. Mixed type in 1 case (4.4%), presented with headache. MRI findings were complex. Conclusion: The clinical and MRI manifestations of neurosyphilis are diverse, with significant variations among subtypes. Quantitative imaging biomarkers, including lesion volume and SIR, demonstrated diagnostic utility, particularly in distinguishing parenchymal and meningovascular types. Integrating these biomarkers with clinical evaluation may improve diagnostic precision and facilitate targeted interventions.
Keywords: Neurosyphilis, universal Imitator, syphilis gumma, Magnetic Resonance Imaging, Parenchymal type, Meningovascular type
Received: 27 Jun 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 He, Ma, Jiang, Sheng, Huang and Bai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Cong Huang, No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
Hong Bai, No. 926 Hospital, Joint Logistics Support Force of PLA, Kaiyuan, China
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