Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of neurosyphilis presenting with limbic encephalitis

Kazuto Tsukita, M.D.1)3), Akihiro Shimotake, M.D., Ph.D.1), Mitsuyoshi Nakatani, M.D.1), Yukitoshi Takahashi, M.D., Ph.D.4), Akio Ikeda, M.D., Ph.D.2) and Ryosuke Takahashi, M.D., Ph.D.1)

1)Department of Neurology, Graduate School of Medicine, Kyoto University
2)Department of Epilepsy, Movement Disorders and Physiology, Kyoto University
3)Department of Neurology, Tenri Hospital
4)National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders

A 46-year-old man presented with a history of personality change and memory disturbance for 5 months. He gradually became difficult in doing a daily job. Brain MRI showed abnormal hyperintensity within bilateral mesial temporal lobes on T2 weighted image. Therefore, viral and autoimmune limbic encephalitis was initially suspected. However, because treponemal and non-treponemal specific antibodies were positive in serum and cerebrospinal fluid (CSF), the diagnosis of neurosyphilis was made. Patients of neurosyphilis with mesiotemporal T2 weighted hyperintensity reportedly showed common features such as relatively young age, HIV-negative, subacute cognitive impairment and seizure, as seen in our patient. Neurosyphilis should be included in the differential diagnosis for mesiotemporal abnormality in patients with these features. In addition, in our patient, anti-glutamate receptor ε2 antibody (ELISA) was strongly positive in CSF that suggested additional autoimmune pathophysiological mechanism.
Full Text of this Article in Japanese PDF (832K)

(CLINICA NEUROL, 57: 37|40, 2017)
key words: neurosyphilis, limbic encephalitis, mesial temporal lobe, anti-glutamate receptor ε2 antibody

(Received: 30-Jul-16)