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PubMed2001

[Brain stem and cerebellar atrophy in neurosyphilis].

A 54-year-old man suffered from serologically proven neurosyphilis with tetraspastic syndrome and bladder dysfunction. He showed a pronounced psychopathy with cognitive decline and attention/concentration deficits. MRI showed slowly progressive cerebellar and brainstem atrophy, which has rarely been described over the past decades. During times of higher incidence and prevalence of neurosyphilis, infratentorial atrophy had been described occasionally, but today this clinical manifestation has been all but forgotten.

Atrophy↗

PubMed2005

Differential diagnosis of mesiotemporal lesions: case report of neurosyphilis.

We report a clinical and imaging case of suspected herpes simplex encephalitis subsequently diagnosed as neurosyphilis based on positive antibodies in the CSF. MRI of the brain showed cortical and subcortical lesions in the mesial temporal region, septal area, insula and cingulated gyrus of the right cerebral hemisphere. Neurosyphilis should be included in the differential diagnosis of mesial temporal region lesions on MRI.

Aged↗

PubMed2004

Neurosyphilis.

Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in the course of disease but causes persistent infection in only a subset of infected persons. Individuals with persistent infection or asymptomatic meningitis are at risk for developing symptomatic neurosyphilis if they are not treated with a drug regimen that achieves sufficient drug levels in cerebrospinal fluid to kill the organism. In this article, recent studies that address the risk, diagnosis, and management of neurosyphilis are discussed within the context of a brief review. Particular attention is given to current controversies. In the developed world, these issues are particularly relevant to persons who are infected with HIV.

Animals↗

PubMed1979

Cystoid macular edema as the primary sign of neurosyphilis.

A 34-year-old man had a six-month history of bilateral visual loss that was secondary to cystoid macular edema, which was assumed to be secondary to neurosyphilis on the basis of cerebrospinal fluid serology, cell count, and protein. Good visual acuity was recovered with systemic corticosteroids only after they were used in combination with antitreponemal therapy. This is the first report, to the best of our knowledge, of cystoid macular edema as the primary sign of neurosyphilis documented by fluorescein angiography.

Administration, Oral↗

PubMed1986

The significance of cerebrospinal fluid routine screening for neurosyphilis.

From 1980 to 1985 the cerebrospinal fluid microhaemagglutination assay for Treponema pallidum antibodies (MHA:TP-CSF) was routinely examined from 10 386 consecutive CSF samples of more than 10,000 patients admitted to a large neurological unit in Helsinki. Twenty one patients were considered to have neurosyphilis on the basis of clinical, serological and CSF findings. The MHA:TP-CSF test was positive in 14 patients, in 4 patients the result was undefined, and in 3 patients negative. No false-positive results were obtained. Ten of the patients had no previous history of syphilis demonstrating the value of this type of routine screening, and in only 2 of these patients the diagnosis was suspected by clinicians before the CSF examination. The serum MHA:TP was positive in all examined 18 neurosyphilis patients indicating its value for the routine screening method instead of the CSF examination.

Adult↗

PubMed1993

Meningovascular neurosyphilis in human immunodeficiency virus infection as a differential diagnosis of focal CNS lesions: a clinicopathological study.

The acquired immunodeficiency syndrome (AIDS) appears to alter the course of syphilis and particularly neurosyphilis. We report the case of an HIV-positive patient with two CNS lesions due to vascular complications of neurosyphilis of the meningovascular type, 18 months after he had developed a penile chancre. On admission, CT scans were inconsistent with cerebral toxoplasmosis or CNS lymphoma. At necropsy, histopathological examination showed typical Heubner's endarteritis of the basilar and posterior cerebral arteries. In AIDS patients, superadded meningovascular syphilis must be suspected, especially when CT scanning reveals the presence of multi-focal, low density lesions with the particular characteristics of infarction.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Quetiapine vs. risperidone in treating psychosis in neurosyphilis: a case report.

OBJECTIVE: A 44-year-old male patient presented with agitation, auditory hallucinations, and delusions of persecution was diagnosed as having neurosyphilis. METHODS: He was treated with penicillin G 24 million units/day, risperidone 6 mg/day, and memantine 20 mg/day with partial response to psychotic symptoms and significant extrapyramidal symptoms. RESULTS: On his follow-up, after 5 months, his cognitive status and serological tests remained the same, and his cell count was increased. A second therapy of penicillin was administered without any clinical improvement. On his second hospitalization for severe psychotic agitation after approximately 1 year, quetiapine 1200 mg/day was introduced and the psychiatric state improved immediately without significant side effect. CONCLUSIONS: Quetiapine, which has a low potential for producing extrapyramidal side effects, should be considered in the treatment of psychotic symptoms of neurosyphilis.

Adult↗

PubMedDate not supplied

[Late neurosyphilis: a current disease].

We report 7 cases of neurosyphilis observed over a 13-month period in a Parisian University Hospital. Four patients had meningo-encephalitis and 3 had arteritis with meningitis. Serology for the human immuno-deficiency virus was negative in all cases. The problems raised by the interpretation of serological data are discussed and the criteria of progressive neurosyphilis are underlined.

Adult↗

PubMed1985

Pupillary abnormalities in congenital neurosyphilis.

Pupils in congenital neurosyphilis differ from the classic Argyll-Robertson pupil in acquired cases, and often tend to be large and unreactive. Constriction to pilocarpine in the reported patient would suggest that peripheral parasympathetic damage is responsible for such pupillary findings. Congenital neurosyphilis should be included among the causes of "tonic" pupil.

Female↗

PubMed1988

[Neurosyphilis in HIV infection: persistence after high-dose penicillin therapy].

Ten years after treatment of secondary syphilis a 44-year-old otherwise asymptomatic HIV-infected patient developed acute meningovascular syphilis with multifocal manifestations and neurological deficit. Whether it was a reactivation or new infection could not be established. High-dosage intravenous penicillin treatment failed to eliminate completely the CNS disease process. Inflammatory CSF findings with pleocytosis and demonstration of intrathecally formed specific antibodies, still present a year later, made it likely that the syphilitic infection was persisting. The concurrent HIV infection probably aggravated the course of the neurosyphilis. Serological tests for syphilis should be done in every HIV-infected patient, followed by CSF examination if the results are suspicious. Analogous to the known opportunistic CNS infections, a more extensive period of treatment should also be considered in the case of neurosyphilis in HIV-infected patients.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Incidence, clinical presentation and treatment of neurosyphilis in Denmark 1980-1997.

Neurosyphilis is now a rare disease in the developed countries. In Denmark 92 cases of neurosyphilis were identified in the period 1980-1997. We obtained the hospital records for 77 of these patients and studied the clinical presentation, treatment and result of the treatment. Most patients were treated with penicillin by the intramuscular or intravenous route, but the amounts and duration of the antibiotic treatment varied a lot among the patients. All patients treated with intravenous penicillin were cured.

Anti-Bacterial Agents↗

PubMed1993

Neurosyphilis presenting with optic neuropathy. Report of a case and review.

A patient with neurosyphilis, presenting with severe ocular impairment due to optic neuropathy, is described. In such a case, a low index of clinical suspicion and improper use of syphilitic serologic tests may delay diagnosis. However, specific tests of serum and cerebrospinal fluid are mandatory for the diagnosis. Treatment evaluation necessitates the follow-up of serology and cerebrospinal fluid cell count. Recent changes of therapy recommendations in subjects with neurosyphilis and in those syphilitic patients co-infected with HIV are mentioned.

Aged↗

PubMed2001

Neurosyphilis presenting as herpes simplex encephalitis.

We report the case of a 55-year-old man with neurosyphilis that presented with features of herpes simplex encephalitis. Neurosyphilis is easily diagnosed and treated and should be included in the differential diagnosis of herpes simplex encephalitis.

Encephalitis, Herpes Simplex↗

PubMed1985

Adenovirus ELISA for the evaluation of cerebrospinal fluid in patients with suspected neurosyphilis.

An enzyme-linked immunosorbent assay (ELISA) detecting antibodies against the adenovirus group antigen was used to examine cerebrospinal fluid (CSF) of suspected neurosyphilis patients for serum contamination or blood-brain barrier (BBB) leakage. Adenovirus antibodies are ubiquitous, produce high antibody titers, and rarely cause central nervous system (CNS) infections. Of 52 normal adult sera tested with this ELISA, only one lacked antibodies. CSF from 48 healthy individuals did not present a detectable amount of anti-adenovirus antibodies. CSF from 33 suspected neurosyphilis patients with positive results in the fluorescent treponemal antibody-absorption (FTA-ABS)-CSF test were examined. Eighteen showed anti-adenovirus antibodies indicating contamination of the CSF with peripheral blood or damaged BBB by syphilis or other disease, resulting in questionable CSF treponemal results. The remaining 15 of these patients appeared to be producing their anti-treponemal antibodies in the CNS. This procedure may prove to be of considerable help in excluding false positive FTA-ABS results in CSF samples.

Adenoviridae↗

PubMedDate not supplied

Syphilis serology in human immunodeficiency virus-infected patients with symptomatic neurosyphilis: case report and review.

The clinical and serologic diagnosis of syphilis in the human immunodeficiency virus-infected patient may be difficult to make. We have recently seen a case of symptomatic neurosyphilis in such a patient presenting with positive serum and CSF syphilis serology. On the basis of this case and similar cases reported in the literature, we conclude that most, if not all, human immunodeficiency virus-infected patients with symptomatic neurosyphilis will have an elevated serum and CSF syphilis serology. However, experience with additional cases will be necessary in order to validate this conclusion.

Adult↗

PubMedDate not supplied

An evaluation of oligoclonal banding and CSF IgG index in the diagnosis of neurosyphilis.

It can be difficult to determine which patients would benefit from therapy to control central nervous system infection with Treponema pallidum. The authors have followed patients prospectively to evaluate two new diagnostic tests available. They performed lumbar punctures on 107 consecutive patients with syphilis of unknown duration, untreated (n = 19) or with serology that did not decrease sufficiently during follow-up (n = 88). The mean age was 47 years, with 91 males and 16 females. Twelve had neurologic symptoms. In order to establish a gold standard, the authors required the cerebrospinal fluid Venereal Disease Research Laboratory (CSF VDRL) test to be reactive (n = 25). They then examined oligoclonal banding and CSF IgG index as diagnostic tests by comparing them to the gold standard. Oligoclonal banding, abnormal in 20, had a sensitivity of 52% and a specificity of 91%. The CSF IgG index, abnormal in 56, had a sensitivity of 92% and a specificity of 60%. The posttest likelihoods of a positive test result were low, and hence neither test ruled in the diagnosis. With a post-test likelihood (PTL) negative of 4%, a negative CSF IgG index assisted in ruling out the diagnosis. Oligoclonal banding was not a satisfactory test for neurosyphilis. The CSF IgG index appears to help only in ruling out infection. Further effort is needed in developing diagnostic tests to assist the clinician in the diagnosis of neurosyphilis.

Electrophoresis, Agar Gel↗

PubMed1982

New cases of neurosyphilis in Finland.

A more than tenfold increase in the annual incidence of infectious syphilis occurred in Finland during the 60s. Since then about 4 cases per 100 000 per year have been reported to the Central Medical Board. During the 70s, 39 new cases of neurosyphilis, verified by clinical and serological examinations, were recorded. At least 14 of these patients were primarily infected after 1955. The data suggest that new cases of neurosyphilis may turn up in the near future and indicate that intensified epidemiological control is still needed.

Adult↗

PubMed2006

Neuroimaging findings in neurosyphilis.

We report two cases of neurosyphilis with atypical clinical presentations that were compounded by atypical neuroimaging findings. In the first case, MRI brain scan findings were felt to be compatible with mesial temporal sclerosis or herpes simplex encephalitis. The second patient presented with a clinical picture compatible with normal pressure hydrocephalus as well as some degree of ventricular enlargement and prominent periventricular white matter changes by MRI brain scan. He actually underwent ventriculo-peritoneal shunting prior to determination that he had active syphilitic involvement of the central nervous system. Neurosyphilis, "the great imitator," is not only capable of mimicking various other neurological disease clinical presentations, it can also mimic neuroimaging features of various other disease processes as well.

Adult↗