To demonstrate the neuropsychological correlates of atypical neurosyphilis and the importance of delivering assessment results in a culturally sensitive manner. The patient was a 52-year-old African American male with 12years of education who was raised in a rural, southern town and worked as a delivery driver. He was hospitalized after three weeks of altered mental status, memory loss, and seizures. Electroencephalography (EEG) showed left lateralized periodic discharges. Magnetic resonance imaging (MRI) showed hyperintensities in the left hippocampus and amygdala consistent with limbic encephalitis. Cerebrospinal fluid studies revealed lymphocytic pleocytosis and hypoglycorrhachia. Rapid plasma regain and venereal disease tests were positive for syphilis in serum and CSF. He was initially treated with empiric antibiotics and antiseizures medications with modest improvement. His mental status improved after penicillin treatment, and he was discharged after 14days. Repeat MRI showed cortical atrophy in the left medial frontal lobe and left hippocampus. The patient demonstrated executive dysfunction (e.g., set-loss and source memory errors) and poor performance across verbal and visual memory tasks. He also demonstrated an inaccurate understanding of the possible causes of his illness. Feedback was delivered across two sessions: one session to discuss test results and a second session with the patient and his wife to discuss syphilis as a sexually transmitted infection and address the historical context of syphilis among African American men. Neurosyphilis can present as limbic encephalitis and can mimic autoimmune encephalitis and other infectious diseases. Tailoring assessment feedback to a patient's sociocultural context is vital for encouraging continued treatment.
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