Syphilis mimicking idiopathic intracranial hypertension

Abstract

Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH.

Figure 1

Visual fields (Humphrey 30-2) at time of diagnosis. Bilaterally enlarged blind spots.

Figure 2

(A, B) At time of diagnosis. Pronounced bilateral papilloedema with blurred disc margins extending into the upper and lower temporal vascular arcades, peripapillary haemorrhages and moderate retinal vein congestion. (C, D) Complete resorption 7 months later.