Cerebral syphilitic gummata: A case presentation and analysis of 156 reported cases

Neurosurgery

Volumn 64, Issue 3, 2009, Pages 568-575

  Fargen, Kyle M ^a   Alvernia, Jorge E ^b   Lin, Christine S ^a   Melgar, Miguel ^a  

^a UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE   (United States)

^b TULANE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Brain; Case report; Gumma; Latent syphilis; Neurosyphilis; Review

Indexed keywords

GADOLINIUM; PENICILLIN G;

ADULT; AGED; ANTIBIOTIC THERAPY; CASE REPORT; CEREBROSPINAL FLUID EXAMINATION; CLINICAL FEATURE; CONFUSION; CONTRAST ENHANCEMENT; FEMALE; FOLLOW UP; HUMAN; MAJOR CLINICAL STUDY; MALE; NEUROSYPHILIS; NUCLEAR MAGNETIC RESONANCE IMAGING; PRIORITY JOURNAL; REAGIN TEST; REVIEW; SEIZURE; SYPHILIS; TREPONEMA PALLIDUM; VENEREAL DISEASE REACTION TEST;

ANTI-BACTERIAL AGENTS; DIAGNOSIS, DIFFERENTIAL; ENCEPHALITIS; HUMANS; MALE; MIDDLE AGED; NEUROSYPHILIS; PENICILLIN G; TREATMENT OUTCOME;

EID: 62849126836     PISSN: 0148396X     EISSN: None     Source Type: Journal    
DOI: 10.1227/01.NEU.0000337079.12137.89     Document Type: Review

References (126)

1. Agrons GA, Han SS, Husson MA, Simeone F: MR imaging of cerebral gumma. AJNR Am J Neuroradiol 12:80-81, 1991.
2. Ahmad I, Lee WC: Otoneurosyphilis masquerading as neurofibromatosis type II. ORL J Otorhinolaryngol Relat Spec 61:37-40, 1999.
3. Alpers BJ: Gumma of the brain. Am J Syph 23:233-240, 1939.
4. Amyot R: Cerebral gummata [in French]. Union Med Can 69:943, 1940.
5. Ances BM, Danish SF, Kolson DL, Judy KD, Liebeskind DS: Cerebral gumma mimicking glioblastoma multiforme. Neurocrit Care 2:300-302, 2005.
6. Bagdasar D: Surgical treatment of cerebral gummata [in French]. Rev Neurol (Paris) 36:1-30, 1929.
7. Bayerthal: Operative management of neurosyphilis [in German]. Munch Med Wochenschr 51:112, 1904.
8. Benaim J: Cerebral gumma [in Spanish]. Neurocirugia 9:1-7, 1953.
9. Benzick AE, Wirthwein DP, Weinberg A, Wendel GD Jr, Alsaadi R, Leos NK, Zeray F, Sanchez PJ: Pituitary gland gumma in congenital syphilis after failed maternal treatment: A case report. Pediatrics 104:e4, 1999.
10. Berger JR, Waskin H, Pall L, Hensley G, Ihmedian I, Post MJ: Syphilitic cerebral gumma with HIV infection. Neurology 42:1282-1287, 1992.
11. Bianchi M, Frera C: A case of brain gumma. J Neurol Neurosurg Psychiatry 20:133-135, 1957.
12. Bodart G: A case of symptomatic dementia caused by intracerebellar gumma [in French]. J Belge Neurol 35:33, 1935.
13. Bösel J, Klingebiel R, Schielke E: HIV-associated neurosyphilis mimicking acoustic neurinoma. J Neurol 253:250-252, 2006.
14. Bramwell B: Intracranial Tumors. Edinburgh, Y.J. Pentland, 1888.
15. Brightbill TC, Ihmeidan IH, Post MJ, Berger JR, Katz DA: Neurosyphilis in HIV-positive and HIV-negative patients: Neuroimaging findings. AJNR Am J Neuroradiol 16:703-711, 1995.
16. Calhoun FP: Ocular manifestations in a case of hypophyseal syphilis. Am J Ophthalmol Soc 5:952-955, 1922.
17. Castro R, Prieto ES, Aguas MJ, Manata MJ, Botas J, Araujo C, Borges F, Aldir I, Exposto Fda L: Evaluation of the Treponema pallidum particle agglutination technique (TP.PA) in the diagnosis of neurosyphilis. J Clin Lab Anal 20:233-238, 2006.
18. Centers for Disease Control and Prevention: Sexually transmitted diseases. http://www.cdc.gov/std/stats/syphilis.htm. Accessed 4/20/2008.
19. Claude H, Levy-Valensi J: Multiple cerebral syphilitic lesions: Gummata of the corpus callosum [in French]. L'encephale 5:27-43, 1910.
20. Cohen I: The role of syphilis in three surgical cases. Surg Clin North Am 10:617-623, 1930.
21. Cohn E: Gumma of the hypophysis [in German]. Virchows Arch Pathol Anat Physiol Klin Med 240:452-468, 1923.
22. Currie JN, Coppeto JR, Lessell S: Chronic syphilitic meningitis resulting in superior orbital fissure syndrome and posterior fossa gumma: A report of two cases followed for 20 years. J Clin Neuroophthalmol 8:145-159, 1988.
23. Gushing H: Intracranial Tumors: Notes upon a Series of Two Thousand Verified Cases with Surgical-Mortality Percentages Pertaining Thereto. Springfield, Charles C. Thomas, 1932.
24. D'Amore S: Bulbar-cerebellar syndrome due to gumma of the left cerebellar hemisphere [in Italian]. Morgagni 76:103-108, 1934.
25. D'Aunoy R, Friedrichs A, Zoeller A: Gumma of the brain. Am J Syph 14:175-187, 1930.
26. De Franco F: Syphilitic gumma of the third ventricle [in Italian]. Riv Patol Nerv Ment 55:486-500, 1940.
27. De Schweinitz GE: Concerning the ocular symptoms in the subjects of hypophyseal disease with acquired syphilis; with illustrated cases. Arch J Ophthalmol 50:203-216, 1921.
28. Donat R: Regarding syphilitic gumma of the infundibulum [in German]. Virchows Arch Pathol Anat Physiol Klin Med 305:261-276, 1939.
29. Dufour H: Chemical meningitis secondary to syphilitic gumma of the cerebellum [in French]. Rev Neurol (Paris) 25:355, 1913.
30. Eltomey AA, Olin MS, Roberts MP: Cerebellopontine angle gumma. Neurosurgery 15:252-253, 1984.
31. Esser A: A case of gumma of the hypophysis [in German]. Centralbl Allg Path Anat 39:97-103, 1927.
32. Fenyes G, Szobar A: Cerebral gumma diagnosed and surgically treated with success [in German]. Zentralbl Neurochir 23:181-191, 1963.
33. Fink EB: A case of diabetes insipidus associated with syphilis of the hypophysis. Endocrinology 10:317-326, 1926.
34. Fink EB: Gumma of the hypophysis and hypothalamus. Arch Pathol 15:631-635, 1933.
35. Fleet WS, Watson RT, Ballinger WE: Resolution of a gumma with steroid therapy. Neurology 36:1104-1107, 1986.
36. Francois J, Verriest G: Syphilitic gumma of the pituitary [in French]. Ann Ocul (Paris) 189:416-424, 1956.
37. Godt P, Stoeppler L, Wischer U, Schroeder HH: The value of computed tomography in cerebral syphilis. Neuroradiology 18:197-200, 1979.
38. Goulon M, Raphael JC, Chesneh AM, Brunel D, Lamer C: Surgically treated syphilitic gumma of the brain. Computerized tomography findings [in French]. Rev Neurol (Paris) 142:228-232, 1986.
39. Grant FC: A study of the results of surgical treatment in 2, 326 consecutive patients with brain tumor. J Neurosurg 13:479-488, 1956.
40. Gross SW, Stein A, Myerson PG: Surgical treatment of gummas of the brain. Am J Surg 10:78-83, 1942.
41. Gyori E, Lew EO: Unsuspected central nervous system gummas in a case of "cerebral infarct" associated with cocaine use. Am J Forensic Med Pathol 28:208-211, 2007.
42. Hamada J, Nonaka N, Yamaguchi T, Ikeda J, Miura G, Matsukado Y: A case of cerebral gumma [in Japanese]. No Shinkei Geka 16:1207-1210, 1985.
43. Hart G: Syphilis tests in diagnostic and therapeutic decision making. Ann Intern Med 104:368-376, 1986.
44. Hernandez RA: Syphilis of the vocal cords, pituitary body and spinal cord. Am J Syph 8:321-322, 1924.
45. Herrold JM: A syphilitic cerebral gumma manifesting as a brain-stem mass lesion that responded to corticosteroid monotherapy. Mayo Clin Proc 69:960-961, 1994.
46. Horowitz HW, Valsamis MP, Wicher V, Abbruscato F, Larsen SA, Wormser GP, Wicker K: Cerebral syphilitic gumma confirmed by the polymerase chain reaction in a man with human immunodeficiency virus infection. N Engl J Med 331:1488-1491, 1994.
47. Hwang WZ, Hasegawa T, Ito H, Shimoji T, Yamamoto S: Cerebral gumma. Case report. J Neurosurg 63:301-303, 1985.
48. Iartsev VV, Kriuchkov AV, Grekhov VV: A solitary gumma of the third ventricle [in Russian]. Vopr Neirokhir 5:55-58, 1975.
49. Inoue R, Katayama S, Kusakabe T, Mori T, Hori S: Cerebral gumma showing linear dural enhancement on magnetic resonance imaging-case report. Neurol Med Chir (Tokyo) 35:813-817, 1995.
50. Ito F, Hunter EF, George RW, Pope V, Larsen SA: Specific immunofluorescent staining of pathogenic treponemes with a monoclonal antibody. J Clin Microbiol 30:831-838, 1992.
51. Ito M, Sato K, Tada H, Kuru Y: Neurosyphilis manifesting as a focal mass lesion: Computerized tomography and magnetic resonance imaging features-Case report. Neurol Med Chir (Tokyo) 30:194-197, 1990.
52. Kaplan JG, Sterman AB, Horoupian D, Leeds NE, Zimmerman RD, Gade R: Luetic meningitis with gumma: Clinical, radiographic, and neuropathologic features. Neurology 31:464-467, 1981.
53. Katsura S, Suzuki J, Wada T: A statistical study of brain tumors in the neurosurgical clinics in Japan. J Neurosurg 16:570-580, 1959.
54. Katsuta T, Ishihara S, Naito S: A case of cerebral syphilitic gumma [in Japanese]. No Shinkei Geka 30:881-885, 2002.
55. Kawakami K, Kawamoto K, Matsumoto K, Kubota C, Kawamura Y, Matsumura H: A case of cerebral gumma [in Japanese]. CT Kenkyu 12:322-326, 1990.
56. Kazancigil TR, Haluk O: A report of destruction of the pituitary, amaurosis and pituitary amenorrhea [in Turkish]. Turk Tip Cemiy Mecm 14:471-476, 1948.
57. Kennedy FB, Fisher JH: Syphilis of the pituitary body: A case report with review of the literature. Am J Syph Neurol 18:12-23, 1934.
58. Kettle AB: A case of multiple gummata of the brain. Guys Hosp Rep 78:309, 1928.
59. Kinoshita K: Case of cerebral gumma of the left temporal lobe [in Japanese]. No To Shinkei 23:365-368, 1971.
60. Lana-Peixoto MA, Teixeira AL Jr, Tzelikis PF, Campos WR, Curi A, Oréfice F: Asymptomatic intracranial gumma in a patient with syphilitic uveitis and human immunodeficiency virus infection. Scand J Infect Dis 35:343-345, 2003.
61. Larsen SA, Steiner BM, Rudolph AH: Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 8:1-21, 1995.
62. Lechi A: Symmetrical syphilitic gumma of the frontal lobes. Anatomoclinical case [in Italian]. Acta Neurol (Napoli) 25:542-546, 1970.
63. Madsen FF, Pedersen KK, Stubbe-Teglbjaerg P: Cerebral gumma. Br J Neurosurg 1:509-513, 1987.
64. Marra A: A single case of cerebral gumma [in Italian]. Lav Neuropsichiat 27:149-164, 1960.
65. Marra CM, Tantalo LC, Maxwell CL, Dougherty K, Wood B: Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals. Neurology 63:85-88, 2004.
66. Martin P: Tumors of the brain and syphilis. Arch Surg 18:1531-1541, 1929.
67. Merritt HH, Adams RD, Solomon H: Gumma of the central nervous system, in Neurosyphilis. New York, Oxford University Press, 1946, pp 62-66.
68. Merriworth H, Browder J: Gumma of the frontal lobe. Med Times Long Island Med J 59:132-134, 1931.
69. Mitchell HC: A rare intracranial lesion. Dis Nerv Syst 15:235-237, 1954.
70. Morello A, Pappalardo S, Di Leonardo S, De Crescenzo L, Virga G: Efficacy of corticosteroid therapy on cerebral gummas: Risks and implications. J Neurosurg Sci 43:53-57, 1999.
71. Nordman L: Syphilitic cerebral gumma with negative cerebrospinal fluid Wasserman reaction. Treatment and recovery [in French]. Loire Med 89:289-292, 1925.
72. Oblu N: Gumma of the brain, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology. New York, Elsevier, 1975, vol 18, pp 427-434.
73. Oblu N, Stanciu A, Dobrescu G, Sandulescu GH: Syphilitic cerebral gumma [in French]. Neurochirurgie 10:361-369, 1964.
74. Oblu N, Stanciu A, Sandulescu GH, Costachescu E: Syphilitic cerebral gumma. Report of three cases [in French]. Neurochirurgie 16:249-258, 1970.
75. Obrador S: Tuberculoma and syphilitic gumma, in Youmans JR (ed): Textbook of Neurological Surgery. Philadelphia, WB Saunders, 1973, pp 1569-1573.
76. Olivecrona H: The surgical treatment of intracranial tumor, in Handbook of Neurosurgery [in German], New York, Springer-Verlag, 1967, vol 4, part 4, p 300.
77. Paillas J, Roger J, Bonnal J, Tamalet J: Kojewnikov's epilepsia partialis continua following syphiloma in one case and hematoma in another, both subrolandic: Operative data and physiopathological remarks [in French]. Rev Neurol (Paris) 83:302-304, 1950.
78. Pall HS, Williams AC, Stockley RA: Intracranial gumma presenting as cerebral tumour. J R Soc Med 81:603-604, 1988.
79. Parhon CI, Marinesco-Baloiu D: Unilateral choreo-athetoid syndrome in connection with syphilitic gumma of lenticular nucleus [in French]. Bull Acad Med Roumanie 1:706-709, 1936.
80. Paterson JE, Leslie M: Gumma of the brain. Br Med J 2:109-111, 1934.
81. Paulian D, Bistricanu J, Jonescu V: Syndrome of left-sided hemiplegia due to multiple thromboarteritic syphilitic cerebral gummata with associated hemorrhage in a case of miliary, latent syphilis. An anatomo-clinical study [in French]. Ann Mal Vener 32:537-543, 1937.
82. Pilleri G, Lechi A, Carreras M: Symmetric syphilitic gummas of the frontal lobes [in German). Arch Psychiatr Nervenkr 219:207-221, 1974.
83. Punt J: Multiple cerebral gummata. Case report. J Neurosurg 58:959-961, 1983.
84. Raskin N: A case of gumma of the brain with hypothalamic symptoms. Am J Syph Gonorrhea Vener Dis 37:156-160, 1953.
85. Régal L, Demaerel P, Dubois B: Cerebral syphilitic gumma in a human immunodeficiency virus-positive patient. Arch Neurol 62:1310-1311, 2005.
86. Rheinberger M, Siris J: Resorption of intracranial gumma under electroencephalographic control. Arch Neurol Psychiatry 44:879, 1940.
87. Rigotti S: Two cases of infratentorial cerebral gummata. An anatomicalpathological study [in Italian]. Atti Soc Med Chir Padova 28:63-102, 1950.
88. Roda JM, Diez-Tejedor E, Alvarez F, Gutierrez M, Blázquez MG: An actual rare brain granuloma: Cerebral gumma. J Neurosurg Sci 29:123-127, 1985.
89. Rodriguez-Arias B, Roca de Vinals R: Anatomo-clinical study on cerebral gumma [in Spanish]. Rev Clin Esp 49:194-197, 1953.
90. Roeske LC, Kennedy PR: Images in clinical medicine. Syphilitic gummas in a patient with human immunodeficiency virus infection. N Engl J Med 335:1123, 1996.
91. Roger H, Cornil L, Arnaud M, Paillas JE: Cerebral syphilitic gumma. Operation and recovery [in French). Rev Neurol (Paris) 73:634, 1941.
92. Salles M, Pecker J: Cerebral syphilitic gumma [in French]. Neurochirurgie 9:91-92, 1961.
93. Sewart JH: Intracranial gumma as a cause of jacksonian epilepsy. J R Nav Med Serv 45:103-107, 1959.
94. Sharp BB, Ellison PO: A case of intracranial tumour. Lancet 1:524-525, 1931.
95. Sheps JG, Simon JL: Solitary cerebral gumma. J Neuropathol Exp Neurol 2:353-364, 1943.
96. Snyder GA, Rickles GA: Intracranial gumma with unusual clinical features. Northwest Med 39:292-295, 1940.
97. Soares-Fernandes JP, Ribeiro M, Maré R, Magalhães Z, Lourenço E, Rocha JF: Diffusion-weighted magnetic resonance imaging findings in a patient with cerebral syphilitic gumma. J Comput Assist Tomogr 31:592-594, 2007.
98. Sotrel A, Multani P: Pathology of the nervous system in HIV-infected patients, in Wormser GP (ed): AIDS and Other Manifestations of HIV Infection. New York, Raven Press, 1992, ed 2, pp 543-584.
99. Southard EE, Solomon HC: Neurosyphilis. Boston, Leonard, 1917.
100. Srivastava VK, Vidyasagar C, Rao TV, Reddy GN, Murthy VS: Cerebral gumma. J Assoc Physicians India 30:337-338, 1982.
101. Standaert DG, Galetta SL, Atlas SW: Meningovascular syphilis with a gumma of the midbrain. J Clin Neuroophthalmol 11:139-143, 1991.
102. Stepan H: A case of cerebral gumma [in German]. Wien Z Nervenheilkd Grenzgeb 4:358-362, 1951.
103. Stroebe H: Gumma of the pituitary body, together with observations upon the occurrence of giant cells and tubercle-formation [in German). Beitr Pathol Anat 36:455-477, 1905.
104. Strong ED: Cerebral gummata. Southwest Med 11:140, 1927.
105. Suarez JI, Mlakar D, Snodgrass SM: Cerebral syphilitic gumma in an HIV-negative patient presenting as prolonged focal motor status epilepticus. N Engl J Med 335:1159-1160, 1996.
106. Takahashi S, Tsukamoto E, Haga A: Successful treatment of a case of cerebral gumma in a young adult [in Japanese]. No To Shinkei 17:1260-1262, 1965.
107. Takeshima H, Kaku T, Ushio Y: Cerebral gumma showing spontaneous regression on magnetic resonance imaging study: Case report. Neurol Med Chir (Tokyo) 39:242-245, 1999.
108. Tamari M: Atrophic degeneration of the cochlea in syphilitic gumma of the medulla oblongata. Arch Otolaryngol 34:1014-1024, 1941.
109. Tien RD, Gean-Marton AD, Mark AS: Neurosyphilis in HIV carriers: MR findings in six patients. AJR Am J Roentgenol 158:1325-1328, 1992.
110. Tomaselli R: Regarding a case of solitary syphilitic cerebral granuloma [in Italian]. Minerva Med 42:237-240, 1951.
111. Tonelli L, Sintini M, Manetto V, Frank F, Torcia E, Mavilla L, Meril GA: Paretic neurosyphilis and cerebral gumma: Case report. J Neurosurg Sci 33:319-322, 1989.
112. Tooth HH: Gumma cerebri. Proc R Soc Med 6:87, 1912-1913.
113. Tsai FY, Schilp AO, Leo JS: Angiographic findings with an intracranial gumma. Neuroradiology 13:1-5, 1977.
114. Uemura K, Yamada T, Tsukada A, Enomoto T, Yoshii Y, Nose T: Cerebral gumma mimicking glioblastoma on magnetic resonance images: Case report. Neurol Med Chir (Tokyo) 35:462-466, 1995.
115. Urechia CI: Gumma of corpus striatum and globus pallidus without extrapyramidal symptoms [in French]. Bull Mem Soc Med Hop Paris 53:608-611, 1929.
116. Virchow R: On the nature of the constitutional afflictions of syphilis [in German]. Arch Pathol Anat Physiol 5:217-336, 1858.
117. Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J: Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings. AJNR Am J Neuroradiol 14:1329-1331, 1993.
118. Wang AM, Barriger TK, Wesolowski DP: Intracranial gumma mimicking a tuber cinereum tumor. Comput Med Imaging Graph 15:57-60, 1991.
119. Weinert LS, Scheffel RS, Zoratto G, Samios V, Jeffman MW, Dora JM, Goldani LZ: Cerebral syphilitic gumma in HIV-infected patients: Case report and review. Int J STD AIDS 19:62-64, 2008.
120. Westphal C: Two cases of syphilis of the brain [in German]. Allg Z Psychiat Psych-Gericht Med 20:481, 1863.
121. Williams JE: Gumma of the brain. Texas State J Med 35:672-676, 1940.
122. Wood CE: Gumma of the pituitary body. Jour A M A 52:700-701, 1909.
123. Wooley PG: Gumma of the pituitary associated with lesions in the spinal cord which may represent early lesions of syringomyelia. J Lab Clin Med 1:155-163, 1915.
124. Yoshinaga M, Suwa M, Ando K: 4 cases of cerebral gumma [in Japanese]. No To Shinkei 13:983-988, 1961.
125. Zanetti G: On the structure and histogenesis of cerebral gummata [in Italian]. Riv Pat Nerv Ment 37:147-265, 1931.
126. Zetola NM, Engelman J, Jensen TP, Klausner JD: Syphilis in the United States: An update for clinicians with an emphasis on HIV coinfection. Mayo Clin Proc 82:1091-1102, 2007.