Electroclinical and radiological observation of dysfunctional zones in a patient with neurosyphilis

Abstract

We report a 33-year-old Japanese man who suffered from repetitive generalized tonic-clonic seizures which were medically intractable. Neurosyphilis was serologically diagnosed in blood and cerebrospinal fluid, and penicillin G (PcG) was consequently effective. The EEG during PcG pre-treatment showed frequent right occipital spikes and right frontocentral slow waves, which disappeared after treatment. During pre-treatment, positron emission tomography with 18-fluorodeoxyglucose and Tc-99m ethyl cysteinate dimer single-photon emission computed tomography revealed occipital hypermetabolism and hyperperfusion (“hot” area) and fronto-temporo-parietal hypometabolism and hypoperfusion (“cool” area) over the right hemisphere. The spike sources of magnetoencephalography during pre-treatment were localized to “hot” areas, and the slow activities were distributed to the fronto-temporo-parietal region, corresponding to “cool” areas. The inflammatory seizure focus and reversible dysfunctional zone associated with neurosyphilis were clearly delineated using these techniques.