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.
surrounding ring shaped areas of low density, no obvious space-occupying effect and no obvious edema.
Fig.
right temporal lobe and no obvious space-occupying effect.
Fig.
extended right lateral fissure cistern, deepened and widened local cortical sulci and decreased total cerebral volume.
Fig.
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.
lobe with borders of obviously abnormal enhancement in strip or ring shape, no obvious central enhancement.
Fig.
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.