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KMID : 1235920100020020078
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Medical Journal of Catholoc University of Daegu
2010 Volume.2 No. 2 p.78 ~ p.80
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An Unusual Presentation of Neurosyphilis as Acute Ataxia and Diplopia
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Lee Kyu-Chul
Seok Jung-Im
Lee Dong-Kuck
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Abstract
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Neurosyphilis refers to infection of the central nervous system by Treponema pallidum. The common forms of neurosyphilis are meningitis, meningovascular disease, general paresis, and tabes dorsalis. We experienced a case of atypical neurosyphilis presented with acute ataxia and unilateral 6th nerve palsy. A 53-year-old man was admitted to the hospital with acute ataxia and diplopia. Ten days before admission, ataxia was developed and slowly aggravated. He was heavy alcoholics and diagnosed as hypertension and diabetes. On examination, his vital signs were stable. Neurologic examination revealed right 6th nerve palsy and ataxia. Muscle strength was normal. Cerebellar function test showed dysmetria and deep tendon reflex decreased in both knee and ankle. Babinski sign was negative. He could not stand without support. Brain MR showed several chronic lacunar infarctions on paramedian, pons, thalamus. Serum Venereal Disease Research Laboratory (VDRL) was positive (1:64) and cerebrospinal fluid (CSF) analysis showed a prominent lymphocytic pleocytosis (190 cells, 100% lymphocytes per mm3) with slightly elevated protein (73 mg/dl). VDRL test of CSF were positive (1:4). His symptoms improved after treatment with penicillin. With respect to differential diagnosis of acute ophthalomoplegia and ataxia, brainstem lesion, Miller-Fisher syndrome, and Wernicke encephalopathy were usually considered. We suggest neurosyphilis should be considered in differential diagnosis of acute ataxia and ophthlalmoplegia.
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KEYWORD
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Neurosyphilis, Acute ataxia, Diplopia
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