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PubMed2001

[Serologic screening for neurosyphilis].

BACKGROUND: Syphilis serology is analysed in all patients admitted as in-patients to the Department of Neurology in Tromsø. In this study we examined the utility of performing routine laboratory testing for syphilis in neurological patients. MATERIAL AND METHODS: We registered all in-patients in the Department of Neurology with a confirmed diagnosis of syphilis during a ten-year period (1990-1999). Additionally, we calculated the cost of performing laboratory tests of all hospitalised patients in this period. RESULTS: From a total of 8,637 patients, we identified five patients with syphilis, one of them with neurosyphilis. This patient had impaired cognitive functions at the time of admittance and a broad spectrum of neurological deficits suggesting a serious neurological disease. A positive syphilis serology confirmed the diagnosis and treatment was initiated. The mean cost for Treponema pallidum serological screening in neurological patients during 10 years was calculated to be about NOK 17,000 per year. INTERPRETATION: Tertiary syphilis is a serious disease with symptoms often mimicking other diseases. Although the laboratory tests for syphilis have been performed in every in-patient admitted to the neurological ward, a speedier diagnosis of neurosyphilis could not be detected in any patient in a ten-year hospital material. Routine serological examination for syphilis in neurological patients is therefore not recommended in this geographical area.

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PubMed1999

Organic brain disease in psychogeriatric patients: impact of symptoms and screening methods on the diagnostic process.

Psychogeriatric patients are mentally affected by a heterogeneous group of diseases, traditionally classified as functional or organic brain disorders (OBDs). Here, we evaluate screening procedures with respect to revelation of underlying OBD. Fifty consecutive patients admitted to a psychogeriatric unit dedicated to late-onset psychiatric disease were included. Diagnosis at admission, symptoms, and time of onset of disease were determined blindly by an independent, experienced psychiatrist on the basis of referral documents and the interview written at admission. Subsequently, consensus established a clinical diagnosis (after psychiatric and neurologic evaluations) and a final diagnosis after the screening procedures (Cognistat and MMS-tests, electroencephalograms, computed tomography, and SPECT). Conventional criteria (ICD-10, ICPC) were used for diagnostic classification. Only 10 of the 50 patients were diagnosed with OBD at admission and an additional 7 patients following full clinical evaluations. At final diagnosis, 34 (of 46) patients were diagnosed with significant OBD. The Cognistat test had the largest diagnostic impact, with sensitivity/specificity values of 81%/60% for OBD.

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