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PubMed1982

Specificity of immunoglobulins synthesized within the central nervous system in neurosyphilis.

Cerebrospinal fluid from four patients with serologically and clinically verified neurosyphilis contained oligoclonal bands when analysed by isoelectric focusing. By antiserum immunofixation these bands consisted by IgG, and by antigen immunofixation and autoradiography the bands were shown to contain treponemal antibodies. Treponemal antibodies synthesized within the CNS were also detected in polyclonal CSF IgG fractions in two of the patients. In one patient with neurosyphilis followed over 2.5 years, local synthesis of IgM and IgA disappeared within 1 year after treatment, while IgG synthesis persisted. In this patient, besides treponemal antibodies, antibodies against herpes simplex virus were also detected in oligoclonal and polyclonal IgG fractions of CSF. The presence of treponemal antibodies synthesized within the CNS was identified in 2 of 16 controls with negative serological tests for syphilis. This might reflect a previous contact with apathogenic treponemes, and the intrathecal antibody synthesis might be a result of an unspecific activation of memory lymphocytes in CNS.

Adult↗

PubMed1984

Juxtapapillary chorioretinitis in neurosyphilis. A case report.

A case of neurosyphilis is described. The presenting symptoms were reduced vision and pain around the left eye. The examination revealed a juxtapapillary chorioretinitis and neurosyphilis with elevated total protein (0.84 g/l) and pleocytosis (250 cells X 10(6)/l) in the cerebrospinal fluid (CFS). Four months after treatment with penicillin for 10 days and prednisolone for 5 weeks, the ophthalmological signs had disappeared. There was no pleocytosis (4 cells X 10(6)/l), and the total protein content in CSF was almost normal (0.52 g/l). Treatment with 6 mill (IU) penicillin G intravenously every 6 h resulted in a concentration in serum and spinal fluid higher than the generally accepted treponemacidal level.

Adult↗

PubMed1985

Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis.

Five patients with laboratory evidence of latent or neurosyphilis were treated orally with doxycycline (200 mg) twice a day for 21 days. After the seventh dose, the mean level of doxycycline in serum was 5.8 micrograms/ml, with a mean drug level in cerebrospinal fluid of 1.3 micrograms/ml. The mean penetration into cerebrospinal fluid was 26%. These preliminary findings suggest that doxycycline, administered orally at a dose of 200 mg twice a day, reaches a sufficient concentration in cerebrospinal fluid to be worthy of further evaluation as an alternative regimen to penicillin therapy for latent or neurosyphilis.

Administration, Oral↗

PubMed1982

Neurosyphilis in the Leicester area.

Twenty patients with neurosyphilis are reviewed. They were gathered over a 15-year period during which the overall incidence was 0.18 per 100,000, though fewer cases appeared in the latter half of the study. The commonest presentation was with mental symptoms and classical forms of neurosyphilis were rarely seen. No patient presented with epilepsy. There is a case for the more selective use of serological testing.

England↗

PubMed1981

Cerebrospinal fluid immunoglobulins in neurosyphilis.

Using the fluorescent treponemal antibody-absorption (FTA-ABS) test and the solid phase haemadsorption assay (SPHA) Treponema pallidum-specific IgA was found in the cerebrospinal fluid (CSF) of patients with neurosyphilis but not in those with late latent syphilis. The presence of T pallidum-specific IgA in the CSF may inhibit the antitreponemal activity of IgG and thus play some part in the pathogenesis of neurosyphilis.

Aged↗

PubMed1986

Neurosyphilis after treatment of latent syphilis with benzathine penicillin.

Two patients developed neurosyphilis after treatment of latent syphilis with intramuscular benzathine penicillin. The cases confirm recent investigations that show that neither benzathine penicillin nor procaine penicillin in the standard doses results in treponemicidal concentrations of penicillin in cerebrospinal fluid. Neurosyphilis can be treated effectively by intravenous benzylpenicillin infusions of 18 to 21.6 g daily for 15 days.

Adult↗

PubMed2003

Treatment of neurosyphilis with ceftriaxone.

The first choice treatment for late syphilis is penicillin. Other than doxycycline, which penetrates the CNS, there are few alternatives for the treatment of neurosyphilis. We report a case of successful treatment of symptomatic neurosyphilis with parenteral ceftriaxone.

Antitreponemal Agents↗

PubMed1990

Variable angiographic findings in patients with stroke and neurosyphilis.

We describe four patients with cerebral infarction and active neurosyphilis who had variable angiographic findings. Patients 1 and 2 had evidence of arteritis and an atheromatous ulcerated stenosis of the extracranial carotid artery, respectively. The third and fourth patients had symptoms of lacunar infarction, but cerebral angiography was normal in patient 3, whereas patient 4 had evidence of concomitant atheromatous and arteritic lesions. Neither age nor presence of cerebrovascular risk factors was of aid in predicting angiographic features. The concomitance of cerebral infarction and active neurosyphilis does not imply a cause-and-effect relation, since atherosclerotic lesions may coexist with arteritis or may even represent the only angiographic feature. Our findings underscore the importance of angiography to confirm the diagnosis in cases of suspected syphilitic arteritis.

Adult↗

PubMed1983

Neurosyphilis revisited. A contemporary wolf in sheep's clothing?

Neurosyphilis has become an uncommon clinical problem, for primary and secondary infections are usually recognised and treated early and successfully. However, patients occasionally receive no treatment for their acute infections--usually because they fail to seek advice--or may receive inadequate therapy when prescribed oral penicillin for other infections. The natural course of the disease is thus influenced, but the syphilis is not cured. Variegated clinical presentations of late disease arise and may make objective diagnosis difficult, especially when this occurs in a clinical setting where neurosyphilis may not be entertained in the initial diagnostic deliberations. Details of three such patients, seen during the last five years in the Aberdeen hospitals, are described--and highlight the range and diversity of clinical presentations which may occur, and typify the problem of making a firm diagnosis while the condition is still potentially curable.

Adult↗

PubMed2006

Effectiveness of olanzapine in neurosyphilis related organic psychosis: a case report.

The clinicians usually do not consider syphilis in the differential diagnosis for patients with acute and chronic psychiatric symptoms. To familiarize clinicians particularly with neurosyphilis (NS) and to discuss the atypical antipsychotic alternatives, we wish to present a case with agitated, resistant psychotic symptoms related to neurosyphilis. The case was a 55-year-old male who has had anxiety, irritability, auditory hallucinations, ataxia, dysarthric speech, paranoid and persecutory delusions and agitated behaviour. Parenteral ziprasidone 20 mg/bid was initialized at the first day of admission to reduce agitation. Then it was switched to olanzapine velotab 10 mg/bid because of inefficacy. Parenteral cephtriaxon 1 g/daily was administered because of seropositive VDRl and TPHA and positive cerebrospinal fluid VDRl. Olanzapine velotab may be a good alternative antipsychotic and should be considered in reducing agitation and psychotic symptoms in NS.

Anti-Bacterial Agents↗

PubMed1981

Neurosyphilis in a young man.

New cases of neurosyphilis are comparatively rare. The epidemiology and clinical presentation of neurosyphilis are described. The article describes the presentation of general paresis in a 34 year old man, 10 years after he had been ineffectively treated with penicillin for secondary syphilis. The various laboratory tests for syphilis are reviewed. The Venereal Disease Research Laboratories (VDRL) is currently the best screening test and the Fluorescent Treponema Antibody-Absorption test (FTA-ABS) is the current recommended specific test for syphilis. Central nervous system involvement is confirmed in the laboratory by a positive VDRL on the cerebrospinal fluid. Physicians should be on the alert for this cause of dementia which may, once again, be increasing in frequency.

Adult↗

PubMedDate not supplied

Prevalence of neurosyphilis at Government Rajaji Hospital, Madurai, India.

Forty patients (34 males and 6 females) with neurological complaints/manifestations and with a past history of multiple sexual partners attending the Government Rajaji Hospital, Madurai, India between April 1992 and October 1992 were investigated for neurosyphilis. Metabolic disorders, hypertension, ischaemic heart disease, arrhythmias and trauma were excluded. Seven males (17.5%) were found to have neurosyphilis. The youngest was 26 years old and the oldest was 47. All were married and of low socioeconomic background. Meningovascular syphilis was the predominant presentation (6:1). Associated cardiovascular involvement was noticed in one of the cases. There was no associated HIV infection in these cases. The incidence is higher than previous reports from this centre.

Adult↗

PubMed2000

Nonconvulsive status epilepticus resulting from Jarisch-Herxheimer reaction in a patient with neurosyphilis.

We report a case of Jarisch-Herxheimer reaction in a patient with neurosyphilis, which was complicated by nonconvulsive status epilepticus. The EEG features suggested a focal seizure onset, although the patient's MRI was normal. JHR is common in the treatment of neurosyphilis, but usually produces only transient systemic constitutional symptoms. Neurologic deterioration is rare, but can be dramatic, as in our patient. NCSE should be considered as an explanation for persistent obtundation and transient focal neurologic findings in this setting.

Cerebral Cortex↗

PubMed1992

Neurosyphilis and schizophrenia.

Neurosyphilis continues to present in atypical forms, leading to erroneous diagnoses by physicians and psychiatrists. This patient, with a previous history of psychosis, presented in a catatonic state with rhabdomyolysis and renal failure. A subsequent breakdown was thought to be schizophrenic until unusual features led to a reassessment and discovery of neurosyphilis which was treated with penicillin and resulted in a remarkable clinical recovery.

Diagnosis, Differential↗

PubMed1985

Neurosyphilis in the antibiotic era.

Among 30 patients with neurosyphilis diagnosed between 1970 and 1981, 43% had symptoms attributable to neurosyphilis, 43% had unrelated symptoms, and 14% were asymptomatic. Serum VDRL was positive in 86%, and the CSF VDRL was positive in 53%. Meningovascular and vascular syphilis were relatively more common than in the prepenicillin era; tabes dorsalis and general paresis were unchanged in relative frequency.

Adult↗

PubMed1990

Neurosyphilis in AIDS patients: initial CSF VDRL may be negative.

We report 2 HIV-seropositive patients with neurosyphilis whose initial CSF VDRL tests were negative. The CSF VDRL became positive after 12 days of IV penicillin treatment for syphilitic meningitis in the 1st patient. The 2nd patient developed syphilitic polyradiculopathy and a positive CSF VDRL 3 months after treatment with IV penicillin. Serial CSF VDRL determinations may be required in AIDS patients when a diagnosis of neurosyphilis is suspected.

Adult↗

PubMed2001

Syphilitic panuveitis and asymptomatic neurosyphilis: a marker of HIV infection.

Co-existing human immunodeficiency virus (HIV) infection can alter the course and presentation of syphilis. Severe ocular manifestations and accelerated natural course of syphilis along with neurosyphilis may be associated with HIV infection. A 30-year-old man is described in whom syphilitic panuveitis and asymptomatic neurosyphilis served as a marker for HIV infection.

Adult↗

PubMed2000

[Dementia caused by neurosyphilis: clinical and neuropsychological follow-up of a patient].

Dementia is one of the manifestations of late syphilis and it is characterized by cognitive deterioration and behaviour disturbances. We report on a male patient with cognitive decline, behaviour disorder, hyperactivity, hallucinations, short-term memory and Argyll Robertson pupils due to neurosyphilis. Minimental state test (MST) was 16. Cerebrospinal fluid (CSF) protein concentration was 82 mg/dl, CSF-leucocyte count 128 cells/mm3 (98% mononuclear cells), CSF-VDRL 1:4, and CSF-T.pallidum haemaglutination assay 1:2560. MRI showed no cerebral alteration, but SPECT revealed left fronto-temporal hypocaptation. He received intravenous penicillin. MST done 3 months after the treatment scored 22. A new spinal tap showed normal CSF. Neurosyphilis should be part of the differential diagnosis of every patient showing cognitive deterioration and behaviour disturbances. During follow-up, MMS is an useful instrument to ++measure cognitive decline and response to treatment.

Behavior↗