Dizziness and progressively poor memory for one year, combined with epilepsy, mental and behavior disorder for 19 days

It is well known that neurosyphilis has various brain MRI manifestations. In this report, we present a rare case with DWI lace-like high signal in cerebral cortex, which is usually seen in Creutzfeldt-Jakob disease (CJD). A 50-year-old male developed dizziness, poor memory, seizures, mental and behavioral disorders, and was admitted to our Emergency Department, where he experienced sudden left hemiplegia. Rapid plasma regain (RPR) and treponema pallidum particle agglutination assay (TPPA) was positive in blood and cerebrospinal fluid (CSF). CSF: 14-3-3 protein (+). Brain MRI showed high FLAIR signals in the right frontal lobe, temporal lobe, insular lobe, occipital lobe and thalamus before the treatment. As for this patient, it was difficult to differentiate CJD from neurosyphilis at first. He was given penicillin treatment and responded well. Those lesions in brain MRI decreased after treatment. This case was reported to raise the awareness of early treatment of neruosyphilis and showed a special DWI lace-like image of this disease.