Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging

Table 1 Clinical features of syphilitic myelitis with longitudinally extensive myelopathy

Case series	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20
Ref.	[7]	[8]	[9]	[9]	[10]	[11]	[12]	[13]	[14]	[15]	[16]	[17]	[4]	[18]	[18]	[19]	[20]	[21]	[21]	Our case
Age	46	31	17	29	17	28	63	57	36	46	63	38	32	35	30	49	41	36	49	25
Gender	M	M	F	F	M	M	M	F	M	M	M	M	M	M	F	M	M	M	M	M
Clinical features	Gait, sensory disturbance, dysuria	Sensory disturbance, paraparesis	Paraparesis, sensory disturbance, urinary retention	Numbness, sensory disturbance, paraparesis	Paraplegia	Chorioretinitis, spastic paraparesis	Sensory deficit, weakness, urinary disturbance	Paraplegia, urinary retention	Pain, paraparesis	Numbness, pain	Pain, weakness	Pain, weakness, numbness, retained urination	Tingling, numbness	Acute transverse myelitis	Acute transverse myelitis	Gait, paresthesia, loss of pain and temperature, urinary retention	Unconscious, numbness	Paresthesia, ascending paresis in inferior limbs	Loss of bilateral strength, sensory impairment	Sensory disturbance, numbness
Duration	2 wk	10 d	8 d	9 mo	NA	180 d	60 d	3 d	4 mo	7 d	12 d	4 mo	4 mo	2 wk	1 mo	2 wk	NA	NA	NA	7 d
High risk behavior	NA	+	+	+	NA	+	NA	NA	NA	+	NA	+	+	+	NA	+	+	NA	NA	+
HIV infection	NA	NA	NA	NA	+	-	-	-	-	-	-	-	-	-	-	+	+	+	+	-
Blood VDRL	NA	1:640	1:4	1:4	1:16	NA	NA	1:8	Reactive	1:64	1:16	RPR (1:128)	1:16	Reactive	Non-reactive	Reactive	RPR+	NA	NA	TRUST+ RPR (1:16)
Blood TPHA	NA	>1:20480	Reactive	Reactive	FTA-ABS (1:6400)	NA	NA	FTA (3+) TPHA (2+)	1:5120	1:81920	Reactive	4+	1:160	1:5120	1:1280	1:2560	+	NA	NA	+
CSF protein (mg/dL)	High	94	52	54	106	94	200	Normal	243	72	91.70	88	40	123	57	79	NA	NA	NA	148
CSF cells (/μL)	Pleocytosis	120	75	20	180	120	498	Pleocytosis	346	113	303	18	40	115	170	202	NA	NA	NA	110
CSF VDRL	Reactive	1:80	Non-reactive	Non-reactive	NA	+	+	1:2	NA	NA	Reactive	1:16	+	Reactive	Reactive	NA	+	NA	NA	NA
CSF TPHA	Reactive	1:5120	Non-reactive	Reactive	FTA-ABS (1:100)	TPHA+	NA	NA	FTA-ABS (1:320), TPHA (1:640)	NA	NA	NA	NA	NA	NA	+	NA	NA	NA	NA
Spinal MRI	High T2 intensity, abnormal Gd-DTPA enhanced	T3/4 wedge-shaped Gd-DTPA enhanced high intensity, swollen spinal cord	Below the C4 diffuse high signal, candle guttering appearance	T1-T11 abnormal signal, flip-flop sign	NA	T6-T8	LETM, Gadolinium enhancement	Extensive central high T2 signal, enhancement of the dorsal T8-T9	Diffuse high T2 signal, flip-flop sign	T2-T6 high signal, focal Gd-DTPA enhancement	T6-T11 high signal, focal Gd-DTPA enhancement	Ventral part on the level of T6–T7	T5-T12 hyperintense signals	Spine-cord edema from D4 to conus medullaris	Spine-cord edema from cervicodorsal up to conus	High-intensity lesions from C4 to T6	Spinal cord edema from C3-T1	Signal impairment in the spinal cord (T2-T12)	Diffuse hypersignal at several levels	Longitudinally extensive T2 hyperintensities involving C7 to T6
Treatment	Antibiotic therapy	Penicillin, prednisolone	Penicillin	Penicillin, cephalosporins	Penicillin	Penicillin, dexamethasone	Penicillin, dexamethasone	Antibiotic therapy	Penicillin	Penicillin, methylprednisolone	Ceftriaxone, methylprednisolone	Penicillin, prednisolone	Penicillin	Procaine penicillin, Methyl prednisole	Procaine penicillin, donapezil	Penicillin potassium, methylprednisolone	Penicillin	Penicillin	Penicillin	Penicillin
Follow-up duration	NA	16 d	14 d	1 mo	NA	NA	2 yr	4 wk	28 d	21 d	30 d	NA	14 d	6 mo	Lost	2 wk	1 wk	NA	NA	3 mo
Status	Improved	Improved	Complete remission	Improved	Spasticity	NA	Improved	Non improved	Improved	Improved	Improved	Positive effect	NA	Same	NA	Improved	Improved	Complete improvement	Partial improvement	Improved
Repeat CSF finding	NA	TPHA (1:2560), VDRL (1:40)	Cells 9/μL, protein 38 mg/dL	NA	Non-reactive	NA	NA	NA	Reduced	N	Cells 34/μL, protein 45.4mg/dL	NA	NA	NA	NA	NA	MA	NA	NA	Cells 24/μL, protein 65 mg/dL, TPPA +, TRUST 1:1.
Repeat blood finding	NA	TPHA (1:10240), VDRL (1:160)	NA	NA	NA	NA	NA	NA	NA	VDRL (1:16)	RPR (1:4)	RPR (1:64)	NA	NA	NA	NA	NA	NA	NA	TPPA (+), TRUST (1:8)
Repeat MRI finding	Disappearance of intramedullary high intensity areas	Reduction in the intensity of lesions	Reduction in the intensity of lesions	Reduction in the intensity of lesions	NA	NA	NA	Disappearance of the high signal lesion on T2-weighted images	Gadolinium enhancement disappeared, the high signal intensity diminished	NA	Reduction in the intensity of lesions	NA	NA	NA	NA	Reduction in the size of the cervical and thoracic cord lesions	NA	NA	NA	Dissolved with three months' follow up

M: Male; F: Female; NA: Not applicable; VDRL: Venereal disease research laboratory; TPHA: Treponema pallidum hemagglutination assay; LETM: Longitudinally extensive transverse myelitis; RPR: Rapid plasma regain; TRUST: Toluidine red unheated serum test; T: Thoracic; C: Cervical; CSF: Cerebrospinal fluid; HIV: Human immunodeficiency virus; NA: Not applicable; FTA-ABS: Fluorescent treponemal antibody-absorption; +: Positive.