Chronic flaccid quadriparesis from tract specific myelopathy in neurosyphilis

A 53-year-old male presented with progressive weakness in all four limbs, sensory loss, and bladder dysfunction over four months. MRI scans revealed unusual patterns of damage in specific pathways of the spinal cord and brainstem, suggesting a unique type of myelopathy. The patient had a history of untreated syphilis, and after penicillin treatment, his condition significantly improved, linking the myelopathy to neurosyphilis.

• 1
  The patient presented with an unusual combination of persistent flaccid weakness and areflexia alongside tract-specific myelopathy, a novel presentation for neurosyphilis.
• 2
  MRI findings showed specific involvement of the corticospinal tracts and posterior columns, a pattern not commonly associated with syphilitic myelitis.
• 3
  Early recognition and treatment with penicillin led to significant clinical improvement, highlighting the importance of considering neurosyphilis in atypical myelopathies.