The cases were collected retrospectively and are presented in Table 1. Only the last one is detailed.
They were middle-aged men, 4/5 heterosexual, all HIV negative.
They presented a subacute frontal syndrome; in 3 cases the apathy stood out, in the others the mood increased.
All had amnesias and 2 Korsakoff syndrome.
Mild pyramidal signs were present in 3 patients, urinary retention in 2 patients, and ataxia in 1 patient.
When the Folstein Minimental Test (MM) was applied, which measures global cognitive efficiency, and Frontal Assessment Battery (FAB), which assesses frontal functions, the greatest impairment of this confirmed the syndrome.
3 had laconism with or without aphasia.
Two cases with episodes of cerebral ischemia had vascular risk factors.
1.
The cerebrospinal fluid (CSF) was always inflammatory and with reactive VDRL; in one case the serology in blood was negative.
Electroencephalogram (EEG) was abnormal in 3/3 cases; however, structural images were not always abnormal.
In case T, angiography (indicated for cerebral infarction in a young man with non-reactive VDRL in blood and before the CSF study) was compatible with vasculitis.
All patients received high doses of sodium penicillin ev, but the improvement was partial and there were cognitive sequelae.
W was 35 years old, sales supervisor, single, with no relevant background except being a promiscuous; he smoked and drank little, did not consume drugs.
In the second semester of 2008 there was a tendency to isolate, forgetfulness, insomnia, loss of libido, dysarthria, headaches.
There was a mixture of emotional lability and apathy.
He lost his job in April 2009.
In May, a psychiatrist sent him to a neurologist, who requested a battery of tests, including blood VDRL that was reactive.
The general examination was normal.
He was alert and collaborated in the examination, highlighting a frontal syndrome and a mixed non-fluent aphasia.
There were nystagmus in extreme looks, paramimesis, digital gambling, tics of shoulder elevation.
A mild gait ataxia, tendinous lower limb areflexia and urinary retention were dorsal tabes.
The frontal syndrome was expressed in apathy, abulia and imitation behavior.
He was unable to understand complex scenes and interpret proverbs; he often persevered.
He had attentional defects (calculation, retention of figures, automatic series inversion) and there was a mixed non-fluent aphasia.
In MM obtained 9/30 points, in FAB 3/18 points; was unable to abstrate.
He scored better in Colorectal Progressive Matrices (MPC, 25/36 points) and in the semantic association test of the 4th excluded (correct in 7/8 trials).
There were no visual or spatial agnosia, constructive apraxia, ideational, ideomotor or dressing.
There was no digital agnosia or right-to-left disorientation.
CSF showed pleocytosis (130 mononuclea-res, 88% lymphocytes, 10% polynuclear and 2% monocytes), glucose 21 mg/dL and proteins 180 mg/dL.
The VRDL was reactive 1/128.
Brain MRI showed predominance of left frontotemporal dementia and EEG showed irritative and slow activity in the same area.
Serology for HIV was negative, and other humoral tests were normal (liver function, coagulation, hemogram and ESR, vitamin B12, Na, K and Cl, biochemical profile, C-reactive protein, PCR for herpes virus).
He was treated with sodium penicillin 4,000,000 iu ev c/4 hours for 15 days, betamethasone 4 mg ev c/8 hours for 3 days and phenytoin 100 mg c/8 hours.
Treatment was well tolerated and partially effective.
At the beginning of 2010 the basic neurological examination was normal, in MM it was 28/30 points, in MPC 31/36, in FAB 13/18.
A frontal syndrome persisted, with a puerile attitude, failure to judge and speech coherence.
The CSF was normal, with reactive serology at 1/32, which together with the appearance of seizures led to a second treatment with penicillin, 21 days, and to indicate phenytoin valproic acid instead of phenytoin.
She was retired due to disability and lives with her parents.
