Neurosyphilis
Key points
- Neurosyphilis is a slowly progressive and destructive infection of the brain or spinal cord.
- Neurosyphilis occurs in 15 to 20% of all late or Tertiary syphilis infections and is a progressive, life-threatening complication.
- Tests to detect syphilis include detection of antibodies in blood.
- The outcome depends upon the type and extent of disability before treatment is begun.
Definition
Neurosyphilis is a slowly progressive and destructive infection of the brain or spinal cord. It occurs in untreated syphilis many years after the primary infection.
Causes, incidence, and risk factors
Neurosyphilis occurs in 15 to 20% of all late or Tertiary syphilis infections and is a progressive, life-threatening complication. There are 4 different forms of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis.
Asymptomatic neurosyphilis precedes symptomatic syphilis and is present in 15% of those with latent (hidden) syphilis. In this case, abnormalities may be present in the cerebrospinal fluid, but no symptoms are present.
In meningovascular neurosyphilis, cranial nerve palsies and pupil abnormalities may be among a wide variety of symptoms. This may also cause damage to blood vessels resulting in Stroke .
In tabes dorsalis, progressive degeneration of the spinal cord occurs causing an inability to walk.
In general paresis, paralysis, tremors, seizures, and mental decline occur as a result of damage to brain cells. Gummas (inflammatory lesions) may occur anywhere in the brain or spinal cord and can cause a wide variety of neurologic deficits.
Syphilitic aseptic meningitis occurs as a chronic infection and may involve headaches, cognitive changes and cranial nerve abnormalities.
Symptoms
- headache
- Stiff neck
- Irritability
- Poor concentration
- Mental confusion
- Depression
- Visual disturbances
- Abnormal reflexes
- Abnormal gait (walk)
- Incontinence
- Dementia
- Weakness, numbness of lower extremities
- Muscle function/feeling loss
- Muscle contractions
- Muscle atrophy
Note: There may be no symptoms (in the asymptomatic form)
Signs and tests
Tests to detect syphilis include detection of antibodies in blood. These are non-treponemal tests (VDRL, RPR). These are not specific and are used as screening tests. If positive the diagnosis of syphilis is confirmed using treponemal tests (e.g., FTA-Abs or MHATP). In neurosyphilis, it is important to test for VDRL in the spinal fluid.Tests to evaluate the nervous system may include:
Written and revised by
David Cohen, M.D.
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