Clinical Insights into Neurosyphilis Patients with Leptomeningeal Enhancement of Spinal Cord

Background and objectives: This study aims to report the clinical, biological, and imaging features of cross-sectional study of neurosyphilis patients with leptomeningeal enhancement of spinal cord. Here, 51 neurosyphilis patients with leptomeningeal enhancement of spinal cord positivity are described, offering a promise in terms of early diagnosis, thereby enabling timely detection and treatment.

Methods: We retrospectively included all neurosyphilis patients enrolled in this study from December 2019 to January 2024. We identified 51 included patients with leptomeningeal enhancement of spinal cord positivity. Their neuroimaging, socio-demographical, clinical status, presentations, and laboratory manifestations were reported retrospectively.

Results: Magnetic resonance imaging showed lumbar or conus medullaris and cauda equina radial enhancement in 72.7%, leptomeningeal enhancement of cervical spine in 65.9%, and thoracic involvement in 55.3%. Twenty of 51 neurosyphilis patients completed the follow-up. Among the 20 patients, the lesioned region in half of patients was decreased or disappeared after therapy. The predominant phenotype was tabes dorsalis. Median age at onset was 51 years, and 72.5% were male. Urinary incontinence was found in 33.3% of patients, and memory deterioration in 39.2%. The most frequent physical sign was Argyll Robertson pupil (45.1%). The levels of white blood cells (25/28, 89.3%) and protein concentration (23/28, 82.9%) of cerebrospinal fluid were reduced in more patients after therapy.

Conclusion: In this study, we first concurrently investigated the clinical course and the biological and imaging features of leptomeningeal enhancement of spinal cord. Leptomeningeal enhancement of spinal cord is common with neurosyphilis. Our findings can be useful for raising clinical awareness to select patients with symptoms of myelopathy in whom MRI images should be investigated.