Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of Lissauer form of paretic neurosyphilis with drop attacks and dementia

Taisaku Syouzaki, M.D., Sou Arahata, M.D., Eiichi Araki, M.D., Ph.D., Hirokazu Furuya, M.D., Ph.D. and Naoki Fujii, M.D., Ph.D.

Department of Neurology, Neuro-Muscular Center, National Oomuta Hospital

A 52-year-old man was admitted to our hospital due to drop attack accompanied with progressive right hand's clumsiness and recent memory impairment. Neurological examination revealed postural involuntary movement of the right hand, and impaired finger fine movements. He showed mild mental deterioration with lower MMSE score. Toreponema Pallidum Latex immuno Assay (TPLA) titers in serum and cerebrospinal fluid (CSF) were remarkably elevated. MRI revealed cerebral atrophy in the left hemisphere. The 99mTc-ECD SPECT analysis showed reduced cerebral blood flow in the left hemisphere. EEG showed slow background activity in the left hemisphere. Drop attacks and involuntary movement were diminished by the administration of the valproate. We diagnosed this case as Lissauer's general paresis and treated with intravenous benzylpenicillin potassium 24 million units per day for 2 weeks. After this treatment, the titer of TPLA in the serum and CSF decreased. The clinical symptoms and signs, the score of MMSE, findings of SPECT and EEG also improved. Although Lissauer's general paresis is a rare form of neurosyphilis, it is important to distinguish this disease in case of progressive dementia and focal neurological signs. Early diagnosis and treatment are the only way to prevent irreversible neurological damage in this disease.
Full Text of this Article in Japanese PDF (693K)

(CLINICA NEUROL, 50: 478|481, 2010)
key words: Lissauer's general paresis, dementia, drop attack, neurosyphilis, Penicillin therapy

(Received: 14-Jan-10)