Clinical characteristics of cerebral syphilitic gumma

Abstract

Objective To analyze the clinical characteristics of cerebral syphilitic gumma. Method The clinical characteristics, brain CT and MRI results and prognosis of 7 patients with cerebral syphilitic gumma admitted in Beijing Ditan Hospital from June 2012 to October 2016 were retrospectively analyzed. Results There were 5 females and 2 males in 7 patients. The symptoms or signs at onset were headache (n=5), increased white blood cells in cerebrospinal fluid (n=6) and increased protein contents in cerebrospinal fluid (n= 6). Total 10 lesions were detected in 7 cases, including 7 in cerebral lobe, and 3 in cerebellum, corpus callosum or intercrural space. The brain MRI showed nodular reinforcement in 5 cases, irregular circular reinforcement in 2 cases and obvious edema around the lesions in 6 cases. The patients were given intravenous infusion of 400 million units common penicillin, q. 4h for 2 wks, sequential intramuscular injection of 240 million units long-term penicillin q. w for 3 wks. Among 7 patients, 1 case died, 1 case showed symptomatic improvement and 5 cases obtained complete improvement with the significant imaging improvement. Conclusion Headache is the most common symptom at onset of cerebral syphilitic gumma, and the lesions mostly are located in the cerebral lobes with nodular enhancement in brain imaging, and the prognosis is generally good. Key words: Neurosyphilis; Pathological conditions, signs and symptoms; Magnetic resonance imaging