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PubMedDate not supplied

Bilateral tonic pupils associated with neurosyphilis.

BACKGROUND: To describe 4 patients with bilateral tonic pupils in neurosyphilis. CASES: Four young men had pupillary abnormalities, which involved irregular shapes, large sizes, tonic reactions, and vermiform movements of both pupils with light-near dissociation. Cholinergic supersensitivity defined bilateral tonic pupils. OBSERVATIONS: Neurosyphilis was diagnosed in these patients on the basis of ocular and laboratory findings. CONCLUSIONS: Bilateral tonic pupils may be important as initial findings in neurosyphilis. We conclude that patients with bilateral tonic pupils should undergo serologic tests for syphilis.

Adult↗

PubMed1986

Bladder dysfunction and neurosyphilis.

Neurosyphilis today is a rare problem. We describe a man who presented with organic brain syndrome, psychosis and incontinence, and diagnosis was neurosyphilis with resultant bladder dysfunction. Urodynamic studies defined the voiding dysfunction as detrusor areflexia with a positive bethanechol test. This case reminds us of the necessity of obtaining a test for venereal disease to rule out neurosyphilis in patients with idiopathic voiding dysfunction.

Adult↗

PubMed1980

[Myelin basic protein in cerebrospinal fluid in neurosyphilis (author's transl)].

Myelin basic protein (MBP) was demonstrated in the CSF of 15 out of 41 patients with assumed or ascertained neurosyphilis using a radio-immunoassay. In parenchymatous syphilis (progressive paralysis, tabes dorsalis) more than 50% of patients had MBP-positive CSF independent of immunological findings and previous treatment. CSF of patients with meningovascular neurosyphilis was mostly negative, only in 2 cases with acute symptoms was MBP demonstrable. In one of these patients MBP was no longer demonstrable in the CSF 6 months after treatment. The frequent occurrence of MBP in CSF in parenchymatous neurosyphilis can be taken as evidence of persistence of demyelinising activity even in cases where immunological finding point to "syphilis satis curata" (sufficiently treated syphilis).

Female↗

PubMed2004

Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter?

To identify factors that affect normalization of laboratory measures after treatment for neurosyphilis, 59 subjects with neurosyphilis underwent repeated lumbar punctures and venipunctures after completion of therapy. The median duration of follow-up was 6.9 months. Stepwise Cox regression models were used to determine the influence of clinical and laboratory features on normalization of cerebrospinal fluid (CSF), white blood cells (WBCs), CSF protein concentration, CSF Venereal Disease Research Laboratory (VDRL) reactivity, and serum rapid plasma reagin (RPR) titer. Human immunodeficiency virus (HIV)-infected subjects were 2.5 times less likely to normalize CSF-VDRL reactivity than were HIV-uninfected subjects. HIV-infected subjects with peripheral blood CD4+ T cell counts of < or =200 cells/ mu L were 3.7 times less likely to normalize CSF-VDRL reactivity than were those with CD4+ T cell counts of >200 cells/ mu L. CSF WBC count and serum RPR reactivity were more likely to normalize but CSF-VDRL reactivity was less likely to normalize with higher baseline values. Future studies should address whether more intensive therapy for neurosyphilis is warranted in HIV-infected individuals.

Anti-Bacterial Agents↗

PubMed1991

Syphilis, neurosyphilis, penicillin, and AIDS.

Early neurosyphilis, characterized by meningitis, cranial nerve abnormalities, and cerebrospinal accidents, was first described in patients with syphilis who received inadequate courses of arsphenamine. Although more effective, penicillin at conventional doses does not yield treponemacidal levels in the central nervous system and probably does not eradicate the infecting organisms, suggesting that it works synergistically with the host's immune response in preventing neurosyphilis. Neurosyphilis after penicillin therapy was almost unheard of in the United States until it began to appear in human immunodeficiency virus (HIV)-infected patients. Numerous cases of syphilitic meningitis, cranial nerve abnormalities, and strokes have been reported in the past decade; about one-half of reported patients had received penicillin therapy, often within the previous 6 months. Thus, more intensive diagnostic evaluation, perhaps including routine cerebrospinal fluid analysis, more intensive therapy, for example with at least three doses of benzathine penicillin, and far more rigorous follow-up are indicated in HIV-infected subjects with syphilis. Since the efficacy of conventional therapy is now uncertain, novel approaches to treatment deserve systematic evaluation.

HIV Infections↗

PubMedDate not supplied

Resolution of serum and cerebrospinal fluid abnormalities after treatment of neurosyphilis. Influence of concomitant human immunodeficiency virus infection.

BACKGROUND AND OBJECTIVES: Little is known about resolution of serum and cerebrospinal fluid abnormalities after neurosyphilis treatment, especially in patients infected with human immunodeficiency virus (HIV). GOAL: To examine the time course of resolution of these abnormalities. STUDY DESIGN: Case series of 22 patients with neurosyphilis (13 infected with HIV) with reactive cerebrospinal fluid Venereal Disease Research Laboratory test who underwent at least one lumbar puncture after treatment. RESULTS: Resolution of all serum and cerebrospinal fluid measures was slower in patients infected with HIV. Serum and cerebrospinal fluid abnormalities resolved in most patients not infected with HIV by 30 weeks, and all met Centers for Disease Control and Prevention criteria for cure. One patient infected with HIV failed therapy by Centers for Disease Control and Prevention criteria, and three others had persistent pleocytosis. CONCLUSIONS: HIV-infected patients with neurosyphilis have slower resolution of serum and cerebrospinal fluid abnormalities after therapy. This observation may suggest impaired clearance of Treponema pallidum from the central nervous system.

Antibodies, Bacterial↗

PubMed2006

Neurosyphilis presenting with status epilepticus.

BACKGROUND: With the introduction of antibiotics, neurosyphilis is now considered uncommon, and accurate diagnosis sometimes is problematic as the symptoms and signs are not pathognomonic. REVIEW SUMMARY: We present a 51-year-old man who had a 4-month history of general malaise and subtle cognitive impairment, combined with a normal brain image study, who ultimately developed an episode of status epilepticus as the main manifestation of unrecognized neurosyphilis. CONCLUSION: Because a clinical diagnosis of neurosyphilis is rarely encountered today in the developed world, a high index of suspicion and clinician awareness is very important in early diagnosis.

Frontal Lobe↗

PubMed1998

De novo status epilepticus as the presenting sign of neurosyphilis.

Although the incidence of seizures in neurosyphilis ranges from 14 to 60%, status epilepticus (SE) as a presenting complaint of neurosyphilis is definitely rare. A 44-year-old human immunodeficiency virus (HIV)-negative man with no history of epilepsy suddenly presented with acute mental confusion and was diagnosed as having a de novo complex partial nonconvulsive SE. Cerebrospinal fluid (CSF) findings, neuroimaging, and clinical course indicated that SE was the presenting symptom of an undiagnosed syphilitic meningovasculitis. The case is presented with a review of previous reports to emphasize the differential features and to underscore the importance of considering neurosyphilis among the possible causes of de novo SE.

Adult↗

PubMed1981

The incidence and clinical presentation of neurosyphilis in Greater Copenhagen 1974 through 1978.

The incidence of neurosyphilis in the Greater Copenhagen region was found to be 0.30 per 100,000 inhabitants per year within a 5 year period. This figure is higher than incidence found in other studies from the last decades, but does not represent a statistically significant rise. Using hospital records from relevant departments 23 patients were described. General paresis and meningovascular cases were the most common manifestations. A tendency towards a changing clinical pattern of neurosyphilis was confirmed. Dementia and personality changes were the most frequently observed clinical symptoms. The classical signs of tabes dorsalis were seen in only very few patients. Stroke was a common manifestation. We recommend Standard Serological Tests for Syphilis to be carried out in patients under 60 years of age with cerebrovascular diseases, dementia and in patients where neurosyphilis could be even a remote diagnostic possibility.

Adolescent↗

PubMed1990

High-dose intravenous-penicillin in neurosyphilis: effect on intrathecal synthesis of IgG, IgM, IgA and IgD.

We evaluated occurrence and levels of intrathecal synthesis of IgG, IgM, IgA and IgD by calculating corresponding index values in 8 patients with definite and 4 with suspected or possible neurosyphilis, prior to, during and after high-dose intravenous penicillin therapy. Four patients with active neurosyphilis displayed intrathecal synthesis of IgG, IgM and IgA. Only 2 of them showed elevated IgD index, and both had taboparesis, pleocytosis and positive VDRL in CSF, and simultaneous elevation of the IgG, IgA and especially of the IgM indices. This suggests that intrathecal synthesis of IgD may occur in patients with severe CNS inflammation in response to diffuse CNS treponemal damage. Penicillin therapy incited transitory elevation of one or more of the immunoglobulin index values in most patients, possibly in response to massive treponemal lysis inside the CNS. Thereafter, the values became mostly normalized but exceptions occurred, including one patient who had elevated IgG and IgM index which persisted 31 months after therapy. Our data indicate that determinations of immunoglobulin indices performed on consecutive specimens from individual patients with neurosyphilis may be helpful in the evaluation of treatment.

Adult↗

PubMed1983

Treatment of neurosyphilis with chloramphenicol. A case report.

Although penicillin is the drug of choice in syphilis, treatment failures with benzathine and procaine penicillin have occurred in neurosyphilis. Patients allergic to penicillin have traditionally been treated with tetracycline but, since this drug diffuses poorly into the cerebrospinal fluid, its use in neurosyphilis is uncertain. In the case reported here, a penicillin allergic patient with general paresis of the insane was successfully treated with chloramphenicol. This drug has been used in the treatment of syphilis and achieves high concentrations in the cerebrospinal fluid. Thus chloramphenicol may be a more appropriate agent than tetracycline in treating patients with neurosyphilis who are allergic to penicillin.

Chloramphenicol↗

PubMed2004

Unusual case report: three cases of psychiatric manifestations of neurosyphilis.

Along with the advent of the human immunodeficiency virus (HIV) came a worldwide resurgence of syphilis. The later stages of syphilis, especially neurosyphilis, may present with symptoms of virtually any psychiatric disorder. The authors present three cases of neurosyphilis diagnosed at the Center for Psychiatric Medicine of the University of Alabama at Birmingham, where the patients presented with overwhelmingly psychiatric manifestations. The authors recommend that clinicians have a high index of suspicion of neurosyphilis, which may have an exclusively psychiatric presentation.

Adult↗

PubMed1980

Congenital neurosyphilis and juvenile paresis: a forgotten entity?

Juvenile neurosyphilis is rare and may be arrested or modified in the early stage by antibiotic treatment for intercurrent infections. Inadequate treatment may weaken the signs and symptoms of neurosyphilis so much that a high index of clinical suspicion is required for early and correct diagnosis. It should be remembered, however, that benzathine penicillin does not constitute adequate treatment for neurosyphilis.

Child↗

PubMed1982

Benzathine penicillin G in the treatment of neurosyphilis.

The definition, pathogenesis, incidence, diagnosis, and treatment of neurosyphilis are discussed. Controlled trials of benzathine penicillin in the treatment of neurosyphilis are reviewed, as are recent case reports of benzathine penicillin failures. Although few well-controlled studies exist to document conclusively the efficacy of benzathine penicillin in the treatment of neurosyphilis, its use is recommended in selected situations.

Humans↗

PubMed1984

Neurosyphilis presenting as a focal mass lesion: a case report.

A patient with subacute aphasia and hemiparesis was found to have a low density white matter lesion with mass effect on the computed tomographic (CT) scan. Serological examination and biopsy established the diagnosis of paretic neurosyphilis. This CT appearance has not previously been described in cases of neurosyphilis. Neurosyphilis should be considered as a potentially treatable cause of a cerebral mass lesion.

Biopsy↗

PubMed1983

[Incidence of neurosyphilis and incidence of its clinical forms 1962-1981].

After 1950 it was observed an increase in the incidence of syphilis in the general population and this fact determined an investigation in order to evaluate the possible repercussion of this occurrence on the central nervous system, as an after effect of the elevated incidence. However, in this first study it was verified that there was a progressive and marked decrease of the neurosyphilis incidence in the 1936-1964 period, and that the frequency of meningovascular forms of the disease had increased lately in regard to the parenchymatous forms. The aim of the present work has been the continuation of this study after so many years. The material for this survey consisted of the clinical records of 148 patients picked out from 34.430 cases seen at the Neurological Department of Escola Paulista de Medicina (São Paulo, Brasil), during the 1962-1981 period, i.e., on twenty consecutive years. The results of this complementary investigation have shown instead that the incidence of neurosyphilis remained steady, changing very little every year, with an incidence at the rate of about 1:200. On the other hand, the frequency of the clinical forms of neurosyphilis changed very much. The usual forms such as general paresis and tabes are now scant and the observation of the uncommon forms, seldom seen in the past, is now progressively increasing through the years, so that they are the preponderant clinical forms today.

Brazil↗

PubMed1984

[Neurosyphilis mortality in a psychiatric hospital over a 50-year period].

Through information gathered at the statistical and medical register service it was done a descriptive study of some epidemiologic aspects of neurosyphilis at the Juliano Moreira Hospital (Bahia) in a period of 50 years (1930 - 1979). Coeficients of specific mortality were stablished . The distribution of the disease was analyzed according to sex, diagnosis in relation to the year, decades and periods before and after penicilinotherapy . Based on the results it is possible to conclude that: neurosyphilis has a cyclic character in epidemiologic level; women are more resistant or less exposed to the disease; males are more often affected; with the penicilinotherapy it was observed a progressive decrease of mortality; the last death caused by neurosyphilis at the Juliano Moreira Hospital occurred in 1971.

Brazil↗

PubMed1987

[Intravenous penicillin therapy in high doses in neurosyphilis: study of 62 cases. I. Clinical evaluation].

Sixty-two patients with symptomatic neurosyphilis were treated with 20 or 24 megaunits of intravenous penicillin G daily for 15 to 30 days. The mean follow-up time after the treatment was 30 months. Thirteen patients developed new neurological signs after the treatment. Their diagnosis were: general paresis (9), taboparesis (2), tabes dorsalis (1) and meningovascular neurosyphilis (1). After the treatment, thirty-six patients (58.1%) improved, 22 patients (35.5%) were unchanged and 4 patients (6.4%) deteriorated on clinical grounds. In two patients there was a progression to other forms of neurosyphilis. The results of the treatment of these patients with high doses of intravenous penicillin G were not different from the results verified with classical intramuscular penicillin that were reported in the literature, from the clinical standpoint.

Adolescent↗