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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).

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Conflict of interest:

There is no conflict of interest to declare.

  • 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

Address for correspondence

Marco A. Lima
Avenida Alexandre Ferreira, 420 / apt 403; 22470-220 Rio de Janeiro RJ
Brasil   

Publication History

Received: 12 July 2016

Accepted: 13 September 2016

Article published online:
05 September 2023

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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

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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).