We report a 73-year-old woman with
meningitis-type
neurosyphilis presenting the main symptom of the left total
ophthalmoplegia. Three months after the appearance of the deviation of the eyeball to the inside and ptosis of the left eyelid, the left eyelid was completely closed. On admission, about four months after the appearance of
neurosyphilis, she showed
paralysis of the left oculomotor nerve, trochlearis nerve and abducens nerve, and the right
mydriasis and absent light reflex. She was diagnosed as meningovascular
neurosyphilis because syphilitic
antibodies reactions in both serum and cerebrospinal fluid were highly positive. We treated her with
intravenous infusion drop of
penicillin G (eighteen-million units/day) for ten days, and those symptoms mentioned above other than light reflex were completely recovered. Bilateral internal carotid arteries situated close each other at the supraclinoid portion. The internal carotid arteries were not enhanced on Gd-MRI and the
stenosis of the arteries were not detected on MRA. However, we suppose that the
inflammation of meninges at that portion spreads to the bilateral internal carotid arteries, and that the III, IV and VI nerves close to the left internal carotid artery were damaged. There have been no reports of meningovascular
neurosyphilis with the manifestation of unilateral
ophthalmoplegia. In the patients of meningovascular
neurosyphilis, however, various
cranial nerve palsies can be appeared. Therefore we suggest that
neurosyphilis should always be taken into consideration as differential diagnosis of
cranial nerve palsies.