Neurosyphilis presenting with behaviour change and temporal and frontal lobe MRI abnormalities

Abstract

General paresis is the result of a chronic, slowly progressive meningoencephalitis secondary to central nervous system infection by Treponema pallidum and its onset is insidious with predominant cognitive deficits and neuropsychiatric manifestations. We report a case of a patient who presented with behavioural change and was found to have MRI signal abnormalities in the medial temporal lobe. A viral or autoimmune aetiology was initially pursued prior to the diagnosis of neurosyphilis. The patient’s clinical status and MRI findings improved following a 14-day course of intravenous benzylpenicillin therapy. Neurosyphilis is an easy-to-screen and treatable disease that should be considered in the differential diagnosis in patients presenting with MRI signal abnormalities in the temporal lobes or limbic structures. Early recognition and initiation of treatment may limit cognitive complications and morbidity.