A 31-year-old man presented with a 2-week history of progressive paraparesis, leg numbness and urinary retention. He had no fever. Neurological examination identified paraplegia with hyper-reflexia in both lower limbs. Pain and proprioceptive sensation were decreased below the T7 level. Magnetic resonance (MR) scan of the spine showed a T2-hyperintense lesion extending from the fourth cervical vertebra level to the conus medullaris with the ‘flip-flop sign’ and the ‘candle guttering appearance’ (figure 1). MR scan of the brain was unremarkable. Cerebrospinal fluid (CSF) examination showed an elevated opening pressure (25 cm H2O) with no pleocytosis, glucose 1.7 mmol/L (25% of glycaemia) and protein 1.6 g/L. CSF PCR testing for varicella zoster virus, herpes simplex virus, cytomegalovirus and tuberculous mycobacteria were negative. Serum antiaquaporin 4 antibodies were absent. He …

中文翻译：

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纵向广泛性横贯性脊髓炎：别忘了梅毒

一名 31 岁男性因进行性下肢轻瘫、腿部麻木和尿潴留 2 周就诊。他没有发烧。神经系统检查发现双下肢反射亢进截瘫。疼痛和本体感觉降低到 T7 水平以下。脊柱磁共振 (MR) 扫描显示 T2 高信号病变，从第四颈椎水平延伸至脊髓圆锥，具有“触发器征”和“烛光样外观”（图 1）。脑部 MR 扫描无异常。脑脊液 (CSF) 检查显示开放压力升高 (25 cm H2O)，无细胞增多，葡萄糖 1.7 mmol/L（血糖的 25%）和蛋白质 1.6 g/L。水痘带状疱疹病毒、单纯疱疹病毒、巨细胞病毒和结核分枝杆菌的脑脊液 PCR 检测均为阴性。血清抗水通道蛋白 4 抗体不存在。他 …