All the cranial nerves were normal on examination except the Argyll Robertson pupil which showed no reaction to the light (Supplementary Video 1). No cerebellar and sensory deficits were detected, and his gait was quite natural. By admission, he has taken on valproate at the dose of 50 mg, twice a day for several months but got no obvious benefit. The medical history consisted of a 4- to 5-year behavioral change and memory decline, 3 years of involuntary movements of the face and mouth along with sharp clicking sound, and occasional paroxysmal vertigo and tinnitus. Case ReportĪ 54-year-old man presented to our hospital with frequent epileptic seizures. After treatment with penicillin, PLED disappeared and seizures diminished, but rhythmic orofacial involuntary movements and Argyll Robertson pupil seem to be unresponsive to treatment and still persisted during wakefulness. Meanwhile, his electroencephalogram (EEG) revealed periodic lateralized discharges (PLEDs) consisting of triphasic waves over the right temporal region. We hereby describe a case of neurosyphilis who presented with severe orofacial involuntary movements, Argyll Robertson pupil, and frequent oral automatism seizures. Until now, the response of different clinical symptoms to penicillin is little known. If untreated, the infections may involve the brain parenchyma, and the conditions would be worsened with the appearance of general paresis, tabes dorsalis, and Argyll–Robertson pupil ( 2). Neurosyphilis shows a wide range of clinical symptoms, including seizures, poor vision, stroke, confusion, and personality changes ( 1). After treatment with penicillin, PLED and seizures disappeared and behavioral changes and memory decline were significantly improved, but rhythmic orofacial involuntary movements and Argyll Robertson pupil persisted, which indicates an irreversible characteristic of late stage neurosyphilis syndromes. In this paper, we analyzed the clinical video-electroencephalogram (EEG) features of neurosyphilis in a 54-year-old man who exhibited with rhythmic orofacial involuntary movements, Argyll Robertson pupil, frequent paroxysmal oral-automatism seizures, periodic lateralized discharges (PLEDs) with triphasic waves, behavioral changes, and memory decline. Patients with neurosyphilis present with a wide range of neurological symptoms, the response of which to penicillin is not well known. 2Department of Neurology, Xing Yuan hospital of Yulin, Shaanxi, China.1Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Xiaoli Wang 1 † Pengying Mu 1,2 † Wenjuan Zhang 1 Yonghong Liu 1 *
0 kommentar(er)
