Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging
Open accessAbstract
BACKGROUND: This article reports a rare case of active neurosyphilis in a man with mild to moderate dementia and marked hippocampal atrophy, mimicking early onset Alzheimer's disease. Few cases have so far described bilateral hippocampal atrophy mimicking Alzheimer's disease in neurosyphilis. CASE PRESENTATION: The patient presented here is a 33 year old Bulgarian male, whose clinical features include progressive cognitive decline and behavioral changes over the last 18 months. Neuropsychological examination revealed mild to moderate dementia (Mini Mental State Examination score was 16/30) with impaired memory and attention, and executive dysfunction. Pyramidal, and extrapyramidal signs, as well as dysarthria and impairment in coordination, were documented. Brain magnetic resonance imaging showed cortical atrophy with noticeable bilateral hippocampal atrophy. The diagnosis of active neurosyphilis was based on positive results of the Venereal Disease Research Laboratory test/Treponema pallidum hemagglutination reactions in blood and cerebrospinal fluid samples. In addition, cerebrospinal fluid analysis showed pleocytosis and elevated protein levels. High-dose intravenous penicillin therapy was administered. At 6 month follow up, improvements were noted clinically, on neuropsychological examinations, and in cerebrospinal fluid samples. CONCLUSION: This case underlines the importance of early diagnosis of neurosyphilis. The results suggest that neurosyphilis should be considered when magnetic resonance imaging results indicate mesiotemporal abnormalities and hippocampal atrophy. Neurosyphilis is a treatable condition which requires early aggressive antibiotic therapy.
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These AD-like deficits can, in some cases, be improved by treatment with penicillin.
“These AD-like deficits can, in some cases, be improved by treatment with penicillin [69].”
From What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease? (2025) · cites this paper as [69]
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Phuna, Z. X., & Madhavan, P. (2023) · International Journal of Neuroscience · doi:10.1080/00207454.2022.2045290 · Cited by 12 · see citing works
What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease?
Brutkiewicz, R. R., Cao, W., Morgan, D., Reis, R. S. D., Suryadevara, V., Willette, A. A., Willette, S. A., Wyatt-Johnson, S. K., & Duggan, M. R. (2025) · Trends in Neurosciences · doi:10.1016/j.tins.2025.05.009 · Cited by 3 · see citing works
- Authors
- Mehrabian, S., Raycheva, M., Traykova, M., Stankova, T., Penev, L., Grigorova, O., & Traykov, L.
- Affiliations
- Alexandrovska Hospital (BG)
- Corresponding author
- Mehrabian, Shima
- Venue
- BMC Neurology
- Published
- 2012-09-20
- Volume
- 12
- Issue
- 1
- Pages
- 96-96
- ISSN
- 1471-2377 (ISSN-L)
- PMC
- PMC3517431
- OpenAlex
- W2032806812
- Cited by
- 55
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 10 · 2023: 7 · 2022: 6 · 2021: 5 · 2019: 3 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 3
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Neurology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurology and Historical Studies
- Keywords
- neurosyphilis, dementia, hippocampal atrophy, Treponema pallidum, cerebrospinal fluid pleocytosis, early diagnosis, cognitive decline
- MeSH terms
- Adult, Alzheimer Disease, Atrophy, Dementia, Diagnosis, Differential, Hippocampus, Humans, Magnetic Resonance Imaging, Male, Neurosyphilis
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