What is the role of MRI in the diagnosis of neurosyphilis?

Updated: Jul 17, 2018
  • Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

MRI in syphilitic myelitis demonstrates high-intensity areas on T2-weighted images. That is, intramedullary hyperintensities prevail, along with characteristics of cord atrophy, not dissimilar from the findings seen in subacute combined degeneration. [60]

In meningovascular syphilis, MRI is particularly useful in demonstrating meningeal enhancement, which tends to be patchy and thin. [61, 62] Angiography may show multifocal narrowing of the neurovasculature. Concentric narrowing of the small- and large-caliber vessels may be seen. Smaller vessels may display focal stenosis and dilation (ie, ectasia). Vascular blush has been reported over the convexities. Rare reports of a moyamoya appearance are noted. [63]


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