Neurosyphilis mimicking Miller-Fisher syndrome: A case report and MRI findings

A 36-year-old man presented with rapidly progressive unsteadiness of gait and diplopia. He had horizontal nystagmus, left sixth nerve palsy, severe ataxia, and areflexia. CSF protein content was 2.4 g/L. Despite a pleocytosis, Miller-Fisher syndrome was diagnosed. Two years later, reevaluation revealed active neurosyphilis in the freshly drawn and stored serum and CSF samples. Clinical findings were consistent with tabes dorsalis. MRI showed lesions confined to the posterior columns of the spinal cord.