{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:00:12Z","timestamp":1792166412763,"version":"4.4.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to systematically analyze the clinical and MRI characteristics of four types of neurosyphilis to improve diagnostic accuracy and facilitate early treatment. By deepening the understanding of clinical presentations and MRI findings, this study seeks to enhance differential diagnosis capabilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study analyzing clinical and MRI data from 23 patients diagnosed with neurosyphilis between January 2016 and May 2024. MRI examinations were performed using 3-Tesla scanners (Siemens, Germany; General Electric, United States) with an 8-channel head coil. The imaging protocol included T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted imaging (T1WI-CE) using gadolinium-based contrast agents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 23 cases of neurosyphilis, including 19 males and 4 females, the mean age was 49.2\u202f\u00b1\u202f11.4\u202fyears (range: 27\u201367). Sixteen cases of parenchymal type (69.6%), mainly manifested as progressive cognitive impairment with psycho-behavioral abnormalities. MRI mainly showed bilateral temporal lobe and hippocampal atrophy with signal abnormalities, with or without abnormal signals in other brain parenchyma, and the enhancement patterns were diverse, which may be unenhanced, patchy, or strip enhancement. Three cases of meningovascular type (13.0%), presented with ischemic stroke with short duration and acute onset. MRI mainly showed multiple acute cerebral infarcts with extensive but scattered intracranial lesions. Three cases of syphilis gumma type (13.0%), had a long course of disease and mainly presented with headache. MRI mainly showed multiple lesions in the internal cerebral convexity with significant surrounding edema bands and significant enhancement of the enhanced lesions with adjacent meningeal enhancement. Mixed type in 1 case (4.4%), presented with headache. MRI findings were complex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The clinical and MRI manifestations of neurosyphilis are diverse, with significant variations among subtypes. Quantitative imaging biomarkers, including lesion volume and SIR, demonstrated diagnostic utility, particularly in distinguishing parenchymal and meningovascular types. Integrating these biomarkers with clinical evaluation may improve diagnostic precision and facilitate targeted interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1655101","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T15:50:42Z","timestamp":1758297042000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and imaging findings of neurosyphilis"],"prefix":"10.3389","volume":"16","author":[{"given":"Peng","family":"He","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-hui","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-sheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1017\/neu.2013.53","article-title":"Neurosyphilis in the mixed urban-rural community of the Netherlands","volume":"26","author":"Ouwens","year":"2014","journal-title":"Acta Neuropsychiatr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1159\/000079391","article-title":"Current clinical spectrum of neurosyphilis in immunocompetent patients","volume":"52","author":"Conde-Sendin","year":"2004","journal-title":"Eur Neurol"},{"key":"ref3","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","author":"Workowski","year":"2015","journal-title":"MMWR Recomm Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/OLQ.0000000000000687","article-title":"Reported cases of neurosyphilis among early syphilis cases-United States, 2009 to 2015","volume":"45","author":"de Voux","year":"2018","journal-title":"Sex Transm Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1093\/cid\/ciz331","article-title":"A Nationwide spatiotemporal analysis of syphilis over 21 years and implications for prevention and control in China","volume":"70","author":"Tao","year":"2020","journal-title":"Clin Infect Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1056\/NEJMra1906228","article-title":"Neurosyphilis","volume":"381","author":"Ropper","year":"2019","journal-title":"N Engl J Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1097\/QAI.0b013e318230e1ca","article-title":"Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in new York City","volume":"58","author":"Pathela","year":"1999","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref8","volume-title":"Syphilis and congenital syphilis in Europe \u2013 A review of epidemiological trends (2007\u20132018) and options for response","year":"2019"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"04004","DOI":"10.7189\/jogh.14.04004","article-title":"Syphilis epidemic among men who have sex with men: a global systematic review and meta-analysis of prevalence, incidence, and associated factors","volume":"14","author":"Zheng","year":"2024","journal-title":"J Glob Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e01237","DOI":"10.1016\/j.idcr.2021.e01237","article-title":"Neurosyphilis masquerading as oculomotor nerve palsy in a healthy middle-aged man: case report and review of the literature","volume":"25","author":"Antaki","year":"2021","journal-title":"IDCases"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e206","DOI":"10.1212\/WNL.0b013e318278b5a1","article-title":"Pearls and oy-sters: neurosyphilis presenting as mesial temporal encephalitis","volume":"79","author":"Abdelerahman","year":"2012","journal-title":"Neurology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"439","DOI":"10.2169\/internalmedicine.40.439","article-title":"Neurosyphilis showing transient global amnesia-like attacks and magnetic resonance imaging abnormalities mainly in the limbic system","volume":"40","author":"Fujimoto","year":"2001","journal-title":"Intern Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1212\/wnl.56.5.628","article-title":"MRI hyperintensities of the temporal lobe and external capsule in patients with CADASIL","volume":"56","author":"O'Sullivan","year":"2001","journal-title":"Neurology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"100552","DOI":"10.1016\/j.ejro.2024.100552","article-title":"Autoimmune encephalitis: early and late findings on serial MR imaging and correlation to treatment timepoints","volume":"12","author":"Abunada","year":"2024","journal-title":"Eur J Radiol Open"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.jns.2013.08.019","article-title":"Neuroimaging of six neurosyphilis cases mimicking viral encephalitis","volume":"334","author":"Xiang","year":"2013","journal-title":"J Neurol Sci"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12991-018-0195-1","article-title":"Psychotic mania as the solitary manifestation of neurosyphilis","volume":"17","author":"Seo","year":"2018","journal-title":"Ann General Psychiatry"},{"key":"ref17","volume-title":"Differential diagnosis of intracranial ring-enhancing lesions: a practical approach","author":"Manzella","year":"2019"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/s13760-018-1033-6","article-title":"Magnetic resonance imaging features of gelatinous pseudocysts in cryptococcal meningoencephalitis","volume":"119","author":"Zhang","year":"2019","journal-title":"Acta Neurol Belg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.jns.2012.03.003","article-title":"Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients","volume":"317","author":"Liu","year":"2012","journal-title":"J Neurol Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"252","DOI":"10.7861\/clinmedicine.19-3-252","article-title":"Lesson of the month 1: neurosyphilis mimicking viral encephalitis and ischaemic stroke","volume":"19","author":"Green","year":"2019","journal-title":"Clin Med (Lond)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s10072-017-3115-2","article-title":"Concomitant neurosyphilis and herpes simplex encephalitis in an immunocompetent patient: a case report","volume":"39","author":"Escobar-Valdivia","year":"2018","journal-title":"Neurol Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1007\/s00234-012-1017-9","article-title":"Neurosyphilis: MRI features and their phenotypic correlation in a cohort of 35 patients from a tertiary care university hospital","volume":"55","author":"Nagappa","year":"2013","journal-title":"Neuroradiology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s00281-009-0183-2","article-title":"Central nervous system vasculitis","volume":"31","author":"Scolding","year":"2009","journal-title":"Semin Immunopathol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1080\/00207454.2017.1412963","article-title":"Diversity in clinical manifestations and imaging features of neurosyphilis: obstacles to the diagnosis and treatment (report of three cases)","volume":"128","author":"Liu","year":"2018","journal-title":"Int J Neurosci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"90","DOI":"10.29399\/npa.28323","article-title":"A case of isolated central nervous system Rosai-Dorfman disease","volume":"61","author":"Algul","year":"2024","journal-title":"Noro Psikiyatr Ars"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.jocn.2024.03.031","article-title":"A rare presentation of Rosai-Dorfman disease involving the central nervous system","volume":"123","author":"Adil","year":"2024","journal-title":"J Clin Neurosci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e01824","DOI":"10.1016\/j.idcr.2023.e01824","article-title":"A case of cerebral toxoplasmosis: \u201ceccentric and concentric sign\u201d in MRI","volume":"33","author":"Awang Senik","year":"2023","journal-title":"IDCases"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1655101\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T15:50:43Z","timestamp":1758297043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1655101\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":27,"alternative-id":["10.3389\/fneur.2025.1655101"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1655101","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,19]]},"article-number":"1655101"}}