Patient Cases  -  AIDS Complicated Cerebral Syphilis

Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a female aged 48 years, who had history of paid blood donation and syphilis in the year of 1995. She was definitely diagnosed in Jun. 2003 and had symptoms of intermittent headaches and decreased memory in Jun. 2003. CD4 count was 43 cells/µl.

Imaging demonstrations

Fig. 2-5-1A                        

Fig. 2-5-1 A,B,C Plain axial CT scanning demonstrating flaky areas of high density in right temporal lobe with

surrounding ring shaped areas of low density, no obvious space-occupying effect and no obvious edema.

Fig. 2-5-1 D  Enhanced axial CT scanning, demonstrating obviously abnormal enhancement in faint ring shape in

right temporal lobe and no obvious space-occupying effect.

Fig. 2-5-1 E,F  Axial MR imaging, demonstrating round-liked high T1 signal in right temporal lobe with clear borders,

extended right lateral fissure cistern, deepened and widened local cortical sulci and decreased total cerebral volume.

Fig. 2-5-1 G,H  Axial MR imaging, demonstrating round-liked high T2 signal in right temporal lobe with surrounding

stripped slightly shortened T2 signal, extended right lateral fissure cistern, deepened and widened local cortical sulci

and decreased total cerebral volume.

Fig. 2-5-1j

Fig. 2-5-1 I,J  Contrast-enhanced MR imaging, demonstrating sagittally round-liked high T1 signal in right temporal

lobe with borders of obviously abnormal enhancement in strip or ring shape, no obvious central enhancement.

Fig. 2-5-1 K,L  MR imaging and 3D reconstruction, demonstrating distal occlusion of temporal artery branches of

medium-sized artery in right brain and no blood vessel network in the focal area.

Diagnosis

AIDS complicated cerebral syphilis.

 

Discussion

Occurrence of AIDS complicating syphilis is increasing. Generally, neurosyphilis of AIDS patients can quickly progress

into the advanced stage. Due to the poor immune mediating ability of AIDS patients, intracephalic syphiloma rarely

occurs because syphiloma is a marker indicating reaction of cellular immune mediation to pathogens, which

facilitates controlling spread of infections. The intracephalic manifestations of AIDS complicating cerebral syphilis are

stenosis and occlusion of cerebral blood vessels, which further lead to cerebral infarction, softened foci or bleeding.

Round-liked abnormal signal in right temporal lobe complicating bleeding occurred in this case, which should

necessarily be differentiated from cerebral bleeding or neoplasm bleeding of non-AIDS patients. AIDS complicating

cerebral syphiloma commonly has no obvious clinical symptoms and its imaging examinations demonstrate no

obvious edema and space-occupying effect, while cerebral syphiloma of non-AIDS patients usually have severe

cerebral bleeding and clinical symptoms with triggering factors and therefore its diagnosis is not difficult based on the

combination of case history. Patients with neoplasm bleeding frequently have complicating space-occupying effect

and obvious edema, whose diagnosis is not difficult based on combinations of case history and laboratory findings.