HUEBNER ENDATERITIS

480.All are true regarding neurosyphilis except

a. Vascular neurosyphilis usually appears around 5 to 10 years after primary infection

b. Heubner endarteritis  is the most common form of syphilitic arteritis, affecting small arteries

c. Syphilitic gummas  occur 3 to 10 years after infection

d. General paresis usually presents 10 to 20 years after the initial infection

e. MR imaging shows hyperintense signal on T2-weighted images and contrast enhancement in the posterior spinal cord and dorsal nerve roots.

480.---b

Two types of vascular involvement have been described in neurosyphilis—Heubner endarteritis and Nissl-Alzheimer endarteritis.

The Heubner type is the most common form of syphilitic arteritis, affecting large and medium-sized arteries. Pathophysiologically, there is fibroblastic proliferation of the intima, thinning of the media, and adventitial fibrous and inflammatory changes, resulting in an irregular luminal narrowing and ectasia.

Less frequently, the Nissl-Alzheimer type of arteritis is present, primarily involving small vessels in which a luminal narrowing occurs as a consequence of intense proliferation of endothelial and adventitial cells. Both types of arteritis may lead to vascular occlusion. Moreover, syphilis can be associated with a venous occlusive inflammation.

Tabes dorsalis is a myelopathy associated with atrophic, degenerated, and demyelinated dorsal nerve roots and posterior spinal columns and appears 10 to 20 years after the initial infection . A triad of symptoms (lightning pains, dysuria, and ataxia) and a triad of signs (Argyll-Robertson pupil, areflexia, loss of proprioception) are the characteristics of this disorder . The Argyll-Robertson pupil, seen in both tabes dorsalis and general paresis, is a small, irregular pupil that accommodates but does not react to light.

MR imaging typically demonstrates brain  atrophy associated with hyperintense signal intensity on T2-weighted images and contrast enhancement in the posterior spinal cord and dorsal nerve roots.