Abstract Details

Title Neurosyphilis Presenting With Syringomyelia: An Unusual Reversible Myelopathy

Topic Infectious Disease

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 3-003

Objective To report a rare case of neurosyphilis presenting with reversible syringomyelia, highlighting the diagnostic challenges and the potential for significant recovery with timely antimicrobial therapy.

Background Neurosyphilis, a late manifestation of Treponema pallidum infection, can affect any part of the neuraxis, though spinal cord involvement is uncommon. While it can manifest as syphilitic myelitis or vascular myelopathy, the formation of a syrinx is exceptionally rare, with fewer than five MRI-confirmed cases reported worldwide. The underlying pathophysiology involves chronic meningovascular inflammation and endarteritis obliterans, leading to ischemic necrosis and subsequent cavitary degeneration of the spinal cord. This presentation can mimic other causes of syringomyelia and transverse myelitis, making early recognition of the infectious etiology crucial to prevent irreversible neurological damage.

Design/Methods N/A

Results

A 54-year-old man with no significant comorbidities presented with a two-month history of progressive bilateral lower limb weakness, sensory loss below the T8 level, and urinary urgency. Examination revealed spastic paraparesis with hyperreflexia and bilateral Babinski signs. Thoracic spine MRI demonstrated a longitudinally extensive T2-hyperintense intramedullary lesion from T4 to T10, featuring a central syrinx-like cavity and mild cord expansion without contrast enhancement. The diagnosis was confirmed by cerebrospinal fluid (CSF) analysis, which showed lymphocytic pleocytosis, elevated protein, and reactive VDRL, and FTA-ABS tests. Following a 14-day course of intravenous aqueous crystalline penicillin G, he showed significant motor recovery, improved bladder control, and a partial reduction of the syrinx on one month follow-up MRI.

Conclusions This case illustrates syringomyelia as a rare and reversible manifestation of neurosyphilis. Clinicians should consider syphilis in the differential diagnosis of unexplained syrinx formation or longitudinal spinal cord lesions. Early serologic testing and prompt antimicrobial therapy can lead to favorable neurological and radiologic outcomes.

Authors/Disclosures
Princy D. Lukhi, MD, MBBS PRESENTER	Dr. Lukhi has nothing to disclose.
Mohammad H. Almomani, MD (Unversity of Texas Medical Branch)	Dr. Almomani has nothing to disclose.
Alexandru Lerint, MD (UTMB Neurology)	Dr. Lerint has nothing to disclose.
Michlene Passeri, MD (UTMB)	Dr. Passeri has nothing to disclose.

��ɫ��

��ɫ��