To investigate the clinical manifestations and imaging characteristics of cases with neurosyphilis.

The clinical manifestations and imaging characteristics of the 46 cases with neurosyphilis in the Beijing Ditan Hospital, Capital Medical University from February 2014 to August 2015 were analyzed, retrospectively.

Total of 46 cases were collected with the average age of (50.00±10.78) years old, among whom 33 cases were male and 13 cases were female. The cases were divided into four groups: asymptomatic neurosyphilis group with 8 cases (8/46, 17.4%), with normal results of cranial MRIs; interstitial neurosyphilis group with 9 cases (9/46, 19.6%), among whom 2 cases with normal results of cranial MRIs, 4 cases with acute/old infarctions, 2 cases with multiple abnormal signals in the cortex and one case with enhancement of the dura; parenchyma neurosyphilis group with 28 cases (28/46, 60.9%), among whom 9 cases with normal results of the cranial MRIs, 13 cases with cerebral atrophy, one case with hydrocephalus and 5 cases with ischemia in the lateral ventricle characteristics, the cranial and the lumbar spine MRIs of the 2 myelophthisis cases were normal; syphilitic gumma group with one case(1/46, 2.2%), the cranial MRI results showed enhancement nodule in the right frontal lobe and right cerebellar with edema around. After the antisyphilitic treatment, the MRI returned to normal.

Neurosyphilis had different performance and imaging, it was necessary to list syphilis serological examination as routine examination to reduce misdiagnosis risk.