Question 866
{"accessible":false,"alternatives":[{"id":4377,"text":"cerebral atrophy"},{"id":4378,"text":"cranial nerve enhancement"},{"id":4379,"text":"focal segmental vascular narrowing"},{"id":4380,"text":"leptomeningeal enhancement"},{"id":4381,"text":"regions of cerebral infarction"}],"archived":false,"correctAlternativeId":4377,"explanation":"\u003cp\u003eMeningovascular syphilis is a form of secondary \u003ca href=\"/articles/neurosyphilis\"\u003eneurosyphilis\u003c/a\u003e that manifests months to years after the initial inoculation. Clinically, it is characterized by a prodrome of mild syphilitic meningitis, followed by a cerebral vasculitis. In patients with co-existing\u0026nbsp;HIV, recent research suggests that there may also be evidence of encephalitis mimicking \u003ca href=\"/articles/herpes-simplex-encephalitis\"\u003eherpes simplex\u0026nbsp;encephalitis\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eRadiographically, imaging\u0026nbsp;reveals features of the prodromal syphilitic meningitis, such as \u003ca href=\"/articles/leptomeningeal-enhancement\"\u003eleptomeningeal enhancement\u003c/a\u003e, cranial nerve enhancement,\u0026nbsp;and presence of syphilitic gummas, but also features of cerebral vasculitis and its complications. Thus, segmental vascular narrowing and \u003ca href=\"/articles/intracranial-arterial-beading\"\u003ebeading\u003c/a\u003e may be appreciated on angiographic studies, and regions of cerebral infarction may also be noted. Cerebral atrophy, in the context of \u003ca href=\"/articles/syphilis\"\u003esyphilis\u003c/a\u003e,\u0026nbsp;is classically seen in general paresis, a tertiary manifestation of \u003ca href=\"/articles/neurosyphilis\"\u003eneurosyphilis\u003c/a\u003e\u0026nbsp;that occurs years to decades after inoculation.\u003c/p\u003e","id":866,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/880","nextQuestionPath":null,"relatedArticles":[{"id":54679,"title":"Syphilis","link":"/articles/syphilis?lang=us"},{"id":54670,"title":"Neurosyphilis","link":"/articles/neurosyphilis?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eWhich\u0026nbsp;is \u003cstrong\u003eNOT\u003c/strong\u003e an imaging feature of\u0026nbsp;meningovascular syphilis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/866"}],"attemptsPercentages":[{"alternativeId":"4380","percentage":4},{"alternativeId":"4379","percentage":5},{"alternativeId":"4377","percentage":56},{"alternativeId":"4381","percentage":11},{"alternativeId":"4378","percentage":24}],"promptToLogin":false,"questionManager":false,"articleId":"cns-infectious-diseases"}