Electroclinical and radiological observation of dysfunctional zones in a patient with neurosyphilis

ABSTRACT We report a 33‐year‐old Japanese man who suffered from repetitive generalized tonic‐clonic seizures which were medically intractable. Neurosyphilis was serologically diagnosed in blood and cerebrospinal fluid, and penicillin G (PcG) was consequently effective. The EEG during PcG pre‐treatment showed frequent right occipital spikes and right frontocentral slow waves, which disappeared after treatment. During pre‐treatment, positron emission tomography with 18‐fluorodeoxyglucose and Tc‐99m ethyl cysteinate dimer single‐photon emission computed tomography revealed occipital hypermetabolism and hyperperfusion (“hot” area) and fronto‐temporo‐parietal hypometabolism and hypoperfusion (“cool” area) over the right hemisphere. The spike sources of magnetoencephalography during pre‐treatment were localized to “hot” areas, and the slow activities were distributed to the fronto‐temporo‐parietal region, corresponding to “cool” areas. The inflammatory seizure focus and reversible dysfunctional zone associated with neurosyphilis were clearly delineated using these techniques.