2/ Young adult who has been having dysuria for several days, who also has developed LE weakness leading to difficulty with ambulation. Did have an #URI last week but feels completely improved from that.
3/ Denies numbness, no back/neck pain, no trauma. On exam, has 4/5 strength in bilateral lowers, full strength uppers, has ¾ reflexes on patellar and Achilles with 5-7 beats clonus at the ankle, toes are down-going. No sensory deficits. What’s in your differential? 🤔 Think #UMN
5/ They undergo an MRI T-L spine which is limited by motion but which demonstrates patchy regions of increased signal within the cord (sag STIR, ax T1 post): 
6/ They then undergo #LP which demonstrates:
👉263 WBC (92 lymph, 4 PMN)
👉21 RBC
👉protein 83
👉glucose 47 (serum 119)
NMO antibody was sent and negative. Oligoclonal bands were absent but IgG index was high. CSF culture and biofire were negative. ACE level normal.
👉263 WBC (92 lymph, 4 PMN)
👉21 RBC
👉protein 83
👉glucose 47 (serum 119)
NMO antibody was sent and negative. Oligoclonal bands were absent but IgG index was high. CSF culture and biofire were negative. ACE level normal.
7/ The patient was started on steroids and started to improve. What is your diagnosis at this time?
8/ Unfortunately, because the patient was now ambulatory, they opted to sign out #AMA. After they left, the CSF #VDRL was positive!
9/ Though #tabesdorsalis is the more common late neurologic manifestation of #syphilis, #syphilismyelitis is a rare presenting condition of syphilis. Other rare presentations include meningomyelitis, pachymeningitis, spastic paraparesis and amyotrophy (icjournal.org/search.php?whe…)
10/ Take 🏡 points:
✅Syphilis should always be in your differential with any myelopathy
✅Elevated WBC/VDRL/protein and T. pallidum hemgglutination common
✅Treatment consists of Pen G and has a good prognosis
✅Check HIV status as well
✅Syphilis should always be in your differential with any myelopathy
✅Elevated WBC/VDRL/protein and T. pallidum hemgglutination common
✅Treatment consists of Pen G and has a good prognosis
✅Check HIV status as well
End/ Other thoughts? @caseyalbin @JimmySuhMD @JimSiegler @MicieliA_MD @a_charidimou @EricLawson90 @CajalButterfly @Capt_Ammonia @DrAtulRamesh1 @RamaniBalu1 @DSandsmarkMDPhD @PennNeurology @TJUHNeuroCrit @namorrismd @ShadiYaghi2 @MDNeurocritcare @HopkinsNCCU @PulmCrit @drdangayach
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