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Syphilis: keeping an eye out for the great mimic
  1. Sean Lance1,
  2. Annemarei Ranta1,2,
  3. Evan Jolliffe1
  1. 1 Neurology, Capital and Coast District Health Board, Wellington, New Zealand
  2. 2 Medicine, University of Otago Wellington, Wellington, New Zealand
  1. Correspondence to Dr Sean Lance, Neurology, Capital and Coast District Health Board, Wellington 6021, New Zealand; Sean.Lance{at}

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A 27-year-old woman presented to her optometrist with a 2-week history of improving vision, such that she no longer required corrective lenses. She also had chronic daily headache and pulsatile tinnitus that worsened when lying flat. Direct funduscopy identified bilateral severe optic disc oedema (Frisen grade 4–5) (figure 1). Uncorrected visual acuity was normal bilaterally (prescription 3 years before: OD –2.25D; OS –2.00D). Visual field testing showed mild enlargement of the right eye blind spot only. MR scan of brain showed prominent subarachnoid spaces around the optic nerves with flattening of the posterior poles (figure 2). MR cerebral venogram was normal. Cerebrospinal fluid (CSF) opening pressure was elevated (34 cmH20) and analysis showed a mild pleocytosis with white cell …

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  • Contributors SL and EJ were involved in the conception and design of the authorship. SL drafted the manuscript with support from EJ. EJ and AR provided critical review of the manuscript and all authors approved of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed by Christian Lueck, Canberra, Australia.

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    Phil E M Smith Geraint N Fuller