图1所示。A和B - T1加权冠状位MRI(对比后)和T2加权冠状位MRI(未对比)显示左侧额旁矢状面病变被水肿的半球间区包围。在皮质区和皮质下区，t2加权序列上均可见明显的高强度(B)。对比后，可以注意到左侧额叶和半球间区明显的轻脑膜增强(a)。C和D - MRA和mri - 3d重建显示两个ACAs远端A2段有2个动脉瘤。右侧动脉瘤直径约5mm，左侧动脉瘤直径约3mm，位于A2发育不全同侧段的末端。活检后进行的E - T1加权冠状MRI(对比后)显示既往手术的迹象，左额叶开颅和下腔。在先前的神经影像学调查中，没有额叶皮质肿胀被证实。对比后，轻脑膜增强持续，沿额叶和半球间区延伸。

图2所示。A-F -组织化学和免疫组织化学结果。增厚的纤维化脑膜，坏死和闭塞的血管被炎症浸润包围(A: H&E染色，原放大4倍);明显的纤维壁增厚和明显的管腔狭窄(B:马松三色，10倍);动脉壁内弹性纤维扭曲(C: Weigert染色，10倍);丰富的血管周围巨噬细胞/组织细胞(D:抗CD68抗体染色，10x)和淋巴细胞炎性浸润(E: LCA免疫染色，10x);相邻皮层层组织紊乱和反应性胶质瘤(F: H&E, 10倍)。活检标本与主要累及脑膜血管的慢性炎症过程一致，并与提示神经梅毒的血清学数据相符。注意:实验室检测结果:梅毒螺旋体血凝(TPHA)血清样本检测呈阳性(1:80)。荧光密螺旋体抗体吸收(FTA-ABS)试验显示最低程度的反应性(1+)，检测到总抗密螺旋体抗体(I.C.=16); antitreponemal IgM were negative. Total protein levels in CSF were high (66.8mg/dL). Then, the patient underwent new serological tests that confirmed the presence of total anti-treponemal antibodies (I.C. ranging from 6.2 to 8.9). TPHA proved positive again (1:5120) and VDRL (Venereal Disease Research Laboratory) test was weakly reactive. While awaiting the results of new laboratory studies of blood and CSF, we consulted an infectivologist that recommended oral antibiotic therapy with amoxicillin, possibly followed by specific anti-treponemal therapy with intravenous penicillin 20 MU/day for two weeks, depending on the outcome of the aforesaid microbiological investigations. CSF testing showed a cytometry of about 0.3 L/mm3 and substantial negativity of other parameters (TPHA, FTA-ABS, anti-treponemal IgM and total antibodies), apart from the high value of proteins (66 mg / dl). Blood serum sample still tested positive for TPHA (1:2560) and for FTA-ABS (2+); total anti-treponemal antibodies (I.C.=4,6) were detected and antitreponemal IgM were 0,4. Serological test for HIV was negative. In light of these results, no evidence of an actual activity of the disease in CSF was pointed out. Thus, according to the opinion of the infectivologist there was no indication to treatment with penicillin intravenously; the patient took amoxicillin orally instead, until his discharge, and then assumed dexamethasone and rabeprazole.