Analysis of clinical, imaging characteristics and prognosis of general paresis patients with encephalitis-like culprit lesions

ObjectiveTo investigate the clinical, imaging characteristics and prognosis of patients with general paresis (GP) who present encephalitis-like culprit lesions, and to analyze their association with poor prognosis.MethodsThis retrospective study included 48 patients diagnosed with GP at the Tenth Affiliated Hospital of Southern Medical University from May 2013 to May 2023. In June 2025, the modified Rankin scale (mRS) and activity of daily living (ADL) scale were used for prognostic assessment of all patients. Based on brain magnetic resonance imaging (MRI) findings, patients were divided into two groups: the encephalitis-like culprit lesion group (n=13) and the non-encephalitis-like culprit lesion group (n=35). Clinical baseline data and MRI features were compared between the two groups. Binary logistic regression analysis was performed to identify factors associated with prognosis.ResultsCompared to the non-encephalitis-like culprit lesion group, patients in the encephalitis-like culprit lesion group had significantly higher baseline mRS scores [3 (2, 5) vs. 2 (1, 3), P=0.003] and ADL scores [26 (14, 56) vs. 14 (14, 18), P=0.027]. They also exhibited significantly higher medial temporal lobe atrophy (MTLA) scores [5 (3, 8) vs. 2 (0, 5), P=0.029], a higher prevalence of bilateral MTLA [10/13 (76.9%) vs. 15/35 (42.9%), P=0.036], and a greater incidence of poor prognosis [11/13 (84.6%) vs. 15/35 (42.9%), P=0.010]. No significant differences were observed between the two groups in terms of baseline characteristics, laboratory parameters, or other MRI features (e.g., lacunar lesions, white matter lesions) (all P>0.05). Multivariate logistic regression analysis revealed that older age (OR=1.145, 95% CI: 1.037-1.264, P=0.007) and the presence of encephalitis-like culprit lesions (OR=30.977, 95%CI: 2.721-352.665, P=0.006) were independently associated with poor prognosis in GP patients.ConclusionGP patients with encephalitis-like culprit lesions present with poorer baseline neurological function, more severe medial temporal lobe atrophy, and a significantly increased risk of poor prognosis. This study demonstrates that the presence of such lesions is an independent correlate of poor prognosis in GP.