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Title : A 48 year-old male with both lower legs weakness and urinary dysfunction
Date : July 3, 2010
Contributed by
Eun Seok Kim, MD
Sam Anyang Hospital, Anyang, Korea
Patient History
Age/Sex A 48 year-old male
Chief complaint both lower legs weakness and urinary dysfunction
Present illness A 48 year-old man visited to a urology department when he felt voiding difficulty and abdominal distension and he was diagnosed with benign prostate hyperplasia. But two days later, he visited to a neurology department with acute onset of both lower legs weakness, numbness.
Past medical history The patient has no past history
Physical examination He did not have fever,chills. On general physical examination, the patient appeared well. Neurologic examination Motor grade was checked 4/5 in right leg, 3/5 in left leg. The deep tendon reflex in lower limb were normal. Pinprick and thermal sensations were absent below T10 level. Pathological Babinski signs were not observed in the feet. The patient could rarely walk unsupported.
Initial laboratory findings CBC, Chemistry - Within the normal range. Serum HIV (-) Serum VDRL titer - 1:16 , FTA-ABS – positive CSF VDRL – reactive CSF profile – WBC 0 , Protein 289 mg/dl, glucose 111 mg/dl
Radiologic findings

Question - ID Case of the Week ( July 3, 2010 )
What do you think the most likely diagnosis is ?
Correct Answer
Acute syphilitic transverse myelitis

Spinal myelitis caused by neurosphilis is an extremely rare disease. Positive serological non treponemal and treponemal test and positive VDRL in the cerebrospinal fluid, lesions found in the MRI of the spinal cord are essential for diagnosing with this type of neurosyphilis. In this case, we could not be sure about the duration of the disease because the epidemiological history was not clear(the patient divorced 10 years ago, and denied any other sexual contact). Neurosyphilis may occur at any stage of syphilis. Cases like this should be investigated in order to exclude neurosyphilis; serological non treponemal and treponemal test and CSF VDRL test. A magnetic resonance imaging(MRI) examination of spine shows centrally located hyperintensity occupying more than two thirds of the cross-sectional area of cord.


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