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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(02): 132
DOI: 10.1590/0004-282X20160179
IMAGES IN NEUROLOGY

Syphilis mimicking trigeminal schwannoma

Sífilis imitando schwannoma trigeminal
Gustavo L. F. Honorio
1   Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia, Rio de Janeiro RJ, Brasil.
,
Samila O. Silva
1   Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia, Rio de Janeiro RJ, Brasil.
,
Marcos M. Silva
1   Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia, Rio de Janeiro RJ, Brasil.
,
Marco A. Lima
1   Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia, Rio de Janeiro RJ, Brasil.
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A 20-year-old woman presented with a two-month history of temporal headache and right trigeminal nerve palsy. An MRI showed enlargement and contrast enhancement of the right trigeminal nerve, suggestive of a schwannoma ([Figure A]). Cerebrospinal fluid analysis disclosed: 10 cells/mm3, protein 76mg/dl, glucose 50mg/dl and positive Venereal Disease Research Laboratory test (VDRL). Serum VDRL was 1/256 and the Treponema pallidum haemagglutination was positive. She was treated with IV crystalline penicillin G 2.400.000 U/day for 14 days with clinical and radiological improvement ([Figure B]).

Gummatous cranial nerve palsy is rarely reported[1],[2] as the sole manifestation of syphilis, but should be considered in the differential diagnosis of nerve tumors.

Zoom Image
Figure Axial T1-weighted brain MRI showing enlargement and contrast enhancement in the right trigeminal nerve (A) and resolution after treatment with crystalline penicillin G (B).


Publikationsverlauf

Eingereicht: 12. Juli 2016

Angenommen: 13. September 2016

Artikel online veröffentlicht:
05. September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Seeley WW, Venna N. Neurosyphilis presenting with gummatous oculomotor nerve palsy. J Neurol Neurosurg Psychiatry. 2004;75(5):789. http://doi.org/10.1136/jnnp.2003.025932
  • 2 Hess CW, Rosenfeld SS, Resor SR. Oculomotor nerve palsy as the presenting symptom of gummatous neurosyphilis and human immunodeficiency virus infection: clinical response to treatment. JAMA Neurol. 2013;70(12):1582-3. http://doi.org/10.1001/jamaneurol.2013.1485