Neurosyphilis

The clinical and visual evoked potential (VEP) findings were analysed in 18 patients with anterior ischaemic optic neuropathy. The VEP studies showed a variety of abnormalities which could be interpreted as being the result of subcomponent interaction consequent upon loss or attenuation of the normal macular-derived P100 component. Delay of normal VEP subcomponents was not seen. The VEP findings were non-specific but pointed to a severe disturbance of transmission in optic nerve fibres subserving central vision. No significant changes were observed with time in most cases indicating a static monophasic process with no significant recovery.

Σκοπός της παρούσης εργασίας είναι τόσο να αποτελέσει έναν οδηγό για τον αναγνώστη που ενδιαφέρεται να πληροφορηθεί σχετικά με το «τί είναι η ψυχιατρική», ώστε να διαπιστώσει αν θέλει να εντρυφήσει περισσότερο στο θέμα, όσο και ένα ενδιαφέρον ανάγνωσμα για τον ψυχίατρο ή τον ειδικό του χώρου της ψυχικής υγείας ώστε να εμπλουτίσει τις γνώσεις του ή/και να αποκτήσει αναφορές σχετικά με τις καταβολές του επαγγέλματός του. Η παρούσα ιστορία της ψυχιατρικής προσφέρεται ως υλικό και για περαιτέρω αναζητήσεις. Για αυτό το λόγο έγινε προσπάθεια να αναφερθούν όσο το δυνατόν περισσότερες λεπτομέρειες και πρόσωπα, όχι μόνο όσα πρωταγωνίστησαν, αλλά και αυτά που έπαιξαν ένα διακριτικό πλην σημαντικό ρόλο στην εξέλιξη του ψυχιατρικού κλάδου. Ορμώμενη από τη διάθεση να αποτελέσει ένα υψηλής ποιότητας επιστημονικό ανάγνωσμα, αλλά συνάμα και ευχάριστου περιεχομένου, έγινε προσπάθεια να φωτιστούν όσο το δυνατόν περισσότερο, στα πλαίσια της περιορισμένης έκτασης μιας πτυχιακής εργασίας, οι συνθήκες ειδικού βάρους που γέννησαν, τροποποίησαν ή εκτόπισαν τα σχετικά με την ψυχιατρική γεγονότα. Επιπλέον, θεωρήθηκε σημαντικό να τοποθετηθούν τα γεγονότα αυτά στην ιστορικότητά τους και για το λόγο αυτό αρκετές φορές αναφέρονται πρόσωπα και γεγονότα που δεν σχετίζονται άμεσα με το θέμα, αλλά έμμεσα.

Bouldin TW, Killebrew K, Boone SC, Gay RM. Metastasis of a rectal carcinoid to the posterior fossa. Neurosurgery 1979;5:496-9. 2 Fishman ML, Rosenthal S. Optic nerve metastasis from a mediastinal carcinoid tumour. Br J Opthalmol 1976;60:583-8. Karkos J. Morphological picture of intestinal carcinoid metastasis to the cerebellum. Neuropathol Pol 1971; 9:231-7. 4 Kovachev D, Ruseva V. Carcinoid of the stomach with metastasis into the dura mater. Vutr Boles 1976; 15:98-103. Wagner PK, Gabbert H, Brunner H. Gastric carcinoid with brain metastases.

patients with positive syphilis serology underwent lumbar puncture. Nine patients had longstanding neurosyphilis and had lumbar punctures performed during the course of their follow-up. Of the remaining 249 only 12 demonstrated the presence of TPHA in the CSF. The serum TPHA titre for eight of these 12 patients, and seven of the nine (two having no titre reported) known neurosyphilis patients at the time of original diagnosis, was 1 in 5120 or more. The four remaining newly found CSF positive patients had serum TPHA titres of 1 in 2560. We suggest that a serum TPHA titre of 1 in 2560 or greater should be considered as a criterion when selecting patients for lumbar puncture, especially when there are no clinical signs or symptoms.

Let us try to project ourselves back into the places and minds of physicians and psychiatrists in, say, 1900. When they spoke of disease, what did they mean? They meant, typically, something like syphilis. ‘Know syphilis in all its manifestations and relations,’ declared Sir William Osler (1849–1919), ‘and all things clinical will be added unto you.’ (1). Obviously, this is no longer true. Indeed, how many cases of syphilis do modern medical students see between the time they enroll in school and the time they graduate? In the United States,…

Background : Friedrich Nietzsche (1844-1900), one of the most profound and influential modern philosophers, suffered since his very childhood from severe migraine. At 44 he had a mental breakdown ending in a dementia with total physical dependence due to stroke. From the very beginning, Nietzsche's dementia was attributed to a neurosyphilitic infection. Recently, this tentative diagnosis has become controversial. Objective : To use historical accounts and original materials including correspondence, biographical data and medical papers to document the clinical characteristics of Nietzsche's illness and, by using this pathography, to discuss formerly proposed diagnoses and to provide and support a new diagnostic hypothesis. Materials : Original letters from Friedrich Nietzsche, descriptions by relatives and friends, and medical descriptions. Original German sources were investigated. Biographical papers published in medical journals were also consulted. Results : Nietzsche suffered from migraine without aura which started in his childhood. In the second half of his life he suffered from a psychiatric illness with depression. During his last years, a progressive cognitive decline evolved and ended in a profound dementia with stroke. He died from pneumonia in 1900. The family history includes a possible vascular-related mental illness in his father, who died from stroke at 36. Conclusions : Friedrich Nietzsche's disease consisted of migraine, psychiatric disturbances, cognitive decline with dementia, and stroke. Despite the prevalent opinion that neurosyphilis caused Nietzsche's illness, there is lack of evidence to support this diagnosis. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) accounts for all the signs and symptoms of Nietzsche's illness. This study adds new elements to the debate and controversy about Nietzsche's illness. We discuss former diagnoses, comment on the history of a diagnostic mistake, and integrate for the first time Nietzsche's medical problems.

Abstract
The causes of Friedrich Nietzsche’s mental breakdown in early 1889 and of the subsequent slow decay to end-stage dementia along ten
years will possibly remain open to debate. The diagnosis of syphilitic dementia paralytica, based only on medical anamnesis and physical
examination, was considered indisputable by Otto Binswanger. On the other hand, taking into account recently described diseases, selectively
collected evidence lend some support to alternative hypotheses: basal forebrain meningioma, CADASIL, MELAS and frontotemporal dementia.
Keywords: 19th Century, history of medicine, neurosyphilis, diagnosis.

Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic–pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim o...

The alterations of the midbrain represent a great clinical challenge due to their anatomical location, it confers the passage of multiple tracts between the cerebral cortex and other subcortical structures such as cerebellum, pons and bulb, responsible for sensory-motor and autonomic control, which implies the difficult comprehension of clinical manifestations in the primary medical context, which delays the diagnosis and an adequate therapeutic approach. This article aims to make a clinical anatomical radiological correlation of the dorso-medial syndrome on the midbrain under the context of a patient diagnosed by meningovascular syphilis. The midbrain is the most cephalic portion of the brainstem, extending from the pontomesencephalic junction to join the diencephalon. Its anterior limits are given by the crus cerebri and the interpeduncular fossa, while at a posterior level it is characterized by the presence of the superior and inferior colliculi (1). It contains important fibers that allow the transmission of information between the cerebral cortex, the cerebellum, the pons and the medulla, for which it participates in the processing of auditory and visual information, and movement control (2). Therefore, it is important that the clinician is familiar with the external and internal configuration of the midbrain to facilitate the location of structures that can be injured and identified in neuroimaging techniques. At a clinical level, lesions of the midbrain, as in all structures of the brainstem, can be identified by the presence of cross-over syndromes, where ipsilateral cranial nerve alterations are evidenced that originate at this level associated with con-tralateral sensory or motor alterations (3). According to the literature reviewed, the main etiologies to be identified in brain stem syndromes are vascular, infectious, compressive, demyelinating and traumatic lesions, which give rise to syndromes such as Weber, Benedikt, Parinaud, Nothnagel and finally Claude, as the case may be. which will be described below (Semiological description of the midbrain syndromes-See table 1). Case Report: A 45-year-old man living on the street who consulted for a sudden onset of symptoms characterized by hemiparesis associated with dysdiadochokinesis and left hemiataxia with horizontal diplopia. Due to the limitation of adduction of the right eye, on admission with TA 100/60, fasting blood glucose 89 mg / dl, negative urine toxic tests, skull CT showing greater atrophy than expected for age, with no other detectable lesions, lipid profile within normality and a serology by RPR technique: POSITIVE (1: 256 DILS), FTA ABS: positive, HIV: negative.

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.

We evaluated the use of treponemal serum tests in cerebrospinal fluid (CSF) to diagnose neurosyphilis since CSF-Venereal Disease Research Laboratory (VDRL) is specific but lacks sensitivity. We tested CSF specimens using the following treponemal serum tests: INNO-LIA, Treponema pallidum particle agglutination (TP-PA), Trep-Sure, and Maxi-Syph. The reference standard to calculate sensitivity and specificity was having two or more reactive/positive tests on CSF. The reference standard group included 11 cases that fulfilled the definition of neurosyphilis (reactive CSF-VDRL plus symptoms) and three cases that did not fulfill the definition: two cases had neurologic symptoms but a nonreactive CSF-VDRL, and one had several positive CSF syphilis tests (reactive VDRL and positive treponemal and syphilis polymerase chain reaction) but no history (referred sample). Controls included 18 patients in whom a CSF-VDRL was performed the same week as patients in the reference group. The sensitivity...

Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.

Friedrich Nietzsche developed dementia at the age of 44 years. It is generally assumed that the cause of his dementia was neurosyphilis or general pareisis of the insane (GPI). Others have proposed frontalbased meningioma as the underlying cause. We have reviewed Nietzsche's medical history and evaluated the evidence from the medical examinations he underwent by various physicians. We have viewed the possible diagnosis of GPI or meningioma in light of present neuro-ophthalmic understanding and found that Nietzsche did not have the neurological or neuro-ophthalmic symptoms consistent with a diagnosis of GPI. The anisocoria which was assumed to be Argyll Robertson pupil was present since he was six years of age. He did not have tongue tremor, lacked progressive motor features and lived at least 12 years following the onset of his neurological signs. Furthermore, the headaches that have been attributed to a frontal-based tumour were present since childhood and the pupil abnormality that has been interpreted as an ''afferent pupillary defect" had the characteristics of an abnormality of the efferent pupillary innervation. None of the medical records or photographs suggest there was any ocular misalignment. We concluded that neither diagnosis of GPI nor frontal-based meningioma is convincing. It is likely that Nietzsche suffered from migraines, his blindness in his right eye was a consequence of high progressive myopia associated with retinal degeneration, his anisocoria explained by unilateral tonic pupil, and his dementia by an underlying psychiatric disease.

Authors report a case of a 35-year-old male with right-sided mild paresis, incontinence, dysexecutive syndrome, short-term memory loss and behavioral changes. Bilateral cerebral infarcts in the region of the caudate nuclei and the adjacent white matter were proved by brain MRI and multiple stenoses of the branches of Willis-circle were confirmed by MR angiography. Elevated protein level and pleocytosis were found in the cerebrospinal fluid with intrathecal IgG synthesis. Serum rapid plasma reagin, Treponema pallidum Particle Agglutination test, Treponema pallidum ELISA, liquor Venereal Disease Research Laboratory tests were positive. Meningovascular neurosyphilis was diagnosed. 24M U/day intravenous penicillin-G treatment was given for 14 days. The patient has vascular dementia due to the bilateral strategic infarcts disconnecting the prefrontal circuits; his symptoms are similar to general paresis. Laboratory and radiologic improvement was observed. Still, the patient have severe r...

A serum amoxycillin concentration of 0 11 g/l was established as -being treponemicidal in a rabbit model with orchitis. Seventeen patients treated with amoxycillin 2 g by mouth three times a day plus 500 mg probenecid twice a day attained treponemicidal CSF amoxycillin concentrations. Thus amoxycillin by mouth offers an effective alternative method for treating patients with neurosyphilis.

The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/l. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of <500 cells/l, and viremia, as defined by an HIV-1 RNA count of >50 copies/ ml, were associated with NS in multivariate analysis (P ‫؍‬ <0.001 for each factor). Blood serum rapid plasma reagin (RPR) titers were not associated with early NS (P ‫؍‬ 0.575). For the diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of <500 cells/l were predictors of NS in HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.

Neurosyphilis results from an infection of the brain, meninges and/or the spinal cord and may develop in persons in whom a manifest syphilis has passed untreated. The clinical manifestations are often diverse and may present as a psychiatric disorder. This article reports two cases with neurosyphilis who were followed for 33 and 21 years respectively. In one of these cases neu-ropathological findings are presented. Retrospective evaluations of all medical records were performed to characterize psychiatric and other clinical features, laboratory and brain imaging findings. Both patients presented a variety of psychiatric manifestations and were initially misdiagnosed. The diagnosis was based on positive serology, cerebrospinal fluid, and neuropsychiatric symptoms and supported by brain imaging. There was a marked improvement in both patients after penicillin therapy. In the case with autopsy mixed brain pathology with atrophy of the frontotemporal areas and advanced vascular pathology was seen. These cases emphasize the importance of screening for syphilis, especially in patients with unexplained psychiatric and neuro-logical symptoms and signs.

Background: Neurosyphilis is the tertiary stage of Treponema pallidum infection that involves the central nervous system, which occurs within days or weeks after an initial syphilis infection, especially in immunocompromised patients. The diagnosis of neurosyphilis is quite challenging as it is uncommon and often presents with obscure symptoms since any organ system may be involved. Case presentation: We describe a case of a 40-year-old African man who is human immunodeficiency virus positive with early neurosyphilis who presented with a stiff neck, headache, confusion, restlessness, and a left-sided chest pain; he did not respond to an empiric treatment of ceftriaxone and fluconazole for meningitis, and tramadol for headache. Ten days after admission, he developed generalized tonic–clonic convulsions; on examination he had ipsilateral facial nerve palsy and an oral ulcer, and responded well to benzathine penicillin treatment. Conclusions: Laboratory diagnosis of neurosyphilis is challenging because to date there is no single laboratory test which is considered sensitive enough for diagnosis of the disease, especially in resource-limited settings. Clinical judgment is still an important part of diagnosis; and neurosyphilis should be considered a diagnostic differential in patients with Human Immunodeficiency Virus presenting with central nervous system involvement and in other high-risk patients.

is a difficult diagnosis because of the limitation of standard cerebrospinal fluid (CSF) tests. This limitation means that new markers in CSF tests are needed to establish whether meningitis is present in presumptive cases of CS. b 2 -Microglobulin (b 2 -m) is raised in CSF recovered from neonates with central nervous system (CNS) infections, but it does not correlate with cellular count or proteins in the CSF. We present a preterm newborn with symptomatic CS. First-day CSF showed 50 cells/mm 3 , protein of 220 mg/dL and a b 2 -m concentration of 16.9 mg/dL (normal -2.25 mg/dL). Serial determinations of b 2 -m showed a marked reduction (76%) after 10 days of appropriate treatment. At 30 days of life, b 2 -m was already within the normal range (1.8 mg/dL). Cerebral ultrasonography showed ventricular dilatation, moderate periventricular echogenicity, subependimal hemorrhages, and linear hyperechoic areas in the thalamus and basal ganglia. We suggest that b 2 -microglobulin is very useful in the diagnosis of CNS involvement and in monitoring the response to treatment. In addition, infants with CS may exhibit CNS imaging findings similar to those observed in other intrauterine CNS infections.

Conclusion: In HIV-infected patients with syphilis, RPR titer should be evaluated more frequently when CD4 count 200 cell/mL is associated with treatment failure. Lumbar puncture for the diagnosis of neurosyphilis should be considered in patients with HIV and syphilis co-infection, even in patients with CD4 cell counts >350 cells/mL, and particularly when the HIV VL 10000 copies/mL.

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 (H1V)-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 present

During the first decade of this century, a significant increase in the incidence of syphilis was documented. To study clinical and laboratory characteristics of central nervous system and ocular syphilis. A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient&#39;s myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we dia...

WBCs./mm3 (X109/L) (normal, &amp;amp;amp;amp;amp;lt;3/mm3 [0.003X109/L]) 0.5 (0.0005X109/L) 1 (0.001X109/L) 12 (0.012X109/L) 0.5 (00005X109/L) IgG index (normal, &amp;amp;amp;amp;amp;lt;0.69) 1.36 0.67 0.90 IgG synthesis, mg/d (normal, &amp;amp;amp;amp;amp;lt;3.0 mg/d) 55.25 10.30 28.02 OGB. No. VDRL or TPHAt *CSF indicates ...

Case Report. A 51-year-old African-American man was well until 2 months before his evaluation, when he noted bilateral painless decreased vision in both eyes, as if he were "looking through fog." The visual loss had been gradually progressive during the 2 months. He denied any eye pain or diplopia. Medical history was unremarkable. He had a 15-pack-year history of cigarette smoking and he admitted to drinking 12 beers a week. He denied any malnutrition and was taking no medication. Best-corrected visual acuity was 20/60 in both eyes. The patient correctly identified 2.5 of 14 Ishihara color plates on the right and 1.5 of 14 plates on the left. Pupils were 4 mm in both eyes, round, and reactive to light, somewhat sluggishly, and had a normal near reaction. He had no relative afferent pupillary defect. Intraocular pressure was 10 mm in the right eye and 12 mm in the left eye. Kinetic perimetry revealed constricted visual fields with central scotomas (Fig. 1). Ocular motility examination was unremarkable. The anterior segment and vitreous were normal bilaterally. Funduscopic examination showed bilateral pale disks with a cupto-disk ratio of 0.6 bilaterally and attenuated retinal vessels. The peripheral retinas were normal (Fig. 2).

The importance of investigating the etiology for dementia lies in the possibility of treating potentially reversible dementias. The aims of this retrospective study are to determine the prevalence of potentially reversible dementias among 454 outpatients seen at the Cognitive and Behavioral Neurology Unit, Hospital das Clínicas, São Paulo University School of Medicine - Brazil, between the years of 1991 and 2001, and observe their evolution in follow-up. Among the initial 454 patients, 275 fulfilled the DSM-IV criteria for dementia. Alzheimer&#39;s disease was the most frequent diagnosis (164 cases; 59.6%). Twenty-two cases (8.0%) of potentially reversible dementia were observed, the most frequent diagnoses being neurosyphilis (nine cases) and hydrocephalus (six cases). Full recovery was observed in two patients and partial recovery in 10 patients. Two cases were not treated and eight cases were lost on follow-up. The prevalence found in the present study falls within the range repo...

Background During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient’s myasthenia gravis symptoms and one as meningitis plus ocul...

Neurosyphilis accounts for 56%-70% of all visceral syphilis and is a complication in 5%-10% of cases of untreated syphilis. The aim of this study was to evaluate the epidemiological aspects and clinical presentations of neurosyphilis in Morocco through a series of 201 patients attending the Centre for Neurological Services at the university hospital in Rabat between 1986 and 1997. The mean age of the patients was 41.26 (SD 9.23) years (range: 17-70 years); the majority (91%) were male. The incidence of neurosyphilis in Morocco is high. From 31 cases per year in 1985, it has fallen since 1990 to reach 10 cases in 1997. Among the different clinical presentations recorded, chronic meningoencepahalitis was the commonest, followed by meningovasculitis, tabes dorsalis and optic atrophy.

The psychiatric presentation of advanced neurosyphilis is well documented, yet there is no set protocol to treat these occurrences. This report indexes a 61-year-old African-American male with no known psychiatric history but with a pertinent medical history of neurosyphilis (non-human immunodeficiency virus). He developed an acute episode of disinhibition involving violence and poor executive judgment. The authors' propose that this patient's symptoms of disinhibition may have resulted from syphilitic invasion of frontal–subcortical structures, resulting in either top-down or bottom-up dysregulation and deterioration of social behavior. His episode resolved with administration of monotherapy carbamazepine.

The patient initially presented with bilateral optic neuritis and periventricular cranial MRI abnormalities in the context of syphilis. Blood was positive but cerebrospinal fluid testing was negative for specific syphilis markers and he was oligoclonal cerebrospinal fluid (CSF) band negative. He initially responded well to penicillin and corticosteriod treatment, but went on to develop the clinical syndrome of neuromyelitis optica (NMO). Testing for the presence of the serum autoantibody for aquaporin-4 was negative. This patient appears to represent another case of post-infectious NMO. Possible pathogenesis of this post-syphilis NMO syndrome in the patient is discussed. Multiple Sclerosis 2008; 14: 268—271. http://msj.sagepub.com

Neurosyphilis accounts for 56%-70% of all visceral syphilis and is a complication in 5%-10% of cases of untreated syphilis. The aim of this study was to evaluate the epidemiological aspects and clinical presentations of neurosyphilis in Morocco through a series of 201 patients attending the Centre for Neurological Services at the university hospital in Rabat between 1986 and 1997. The mean age of the patients was 41.26 (SD 9.23) years (range: 17-70 years); the majority (91%) were male. The incidence of neurosyphilis in Morocco is high. From 31 cases per year in 1985, it has fallen since 1990 to reach 10 cases in 1997. Among the different clinical presentations recorded, chronic meningoencepahalitis was the commonest, followed by meningovasculitis, tabes dorsalis and optic atrophy.

Relatamos um caso de obstrução bilateral na origem das artérias carótidas internas, apresentando como sinais/sintomas associados hemiparesia e hipoestesia superficial e profunda à direita, associada a sífilis meningovascular em paciente com SIDA. Tomografia de crânio apresentou pequenas lesões hipodensas, com predomínio à esquerda, e arteriografia evidenciou oclusão bilateral das artérias carótidas. A associação entre lues e SIDA não é infrequente, porém o quadro oligossintomático do paciente, provavelmente devido a oclusão arterial lenta e gradual chama a atenção.

The clinical diagnosis of neurosyphilis is very rarely encountered today in the developed world although syphilis remains a significant health problem in few areas of the industrialized countries and in most of the third world nations. This apparent decline may be due to increase in number of asymptomatic neurosyphilis and cases presenting as subtle, illdefined syndromes rather than classic presentation of tabes dorsalis and general paresis in the post penicillin era. This retrospective study was carried out to report the neurosyphilis cases diagnosed at a tertiary care hospital in North India, and to analyse the laboratory and clinical parameters of these cases. Suspected cases of neurosyphilis presenting at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh over a period of 13 yr (January 1990 to December 2002) were identified. Diagnosis of neurosyphilis was based on clinical presentation, prior history of syphilis, routine CSF biochemistry (protein and ...

Few patients with symptomatic neurosyphilis present with signs and symptoms of acute meningitis. Here we report two cases of syphilitic meningitis diagnosed in HIV patients with meningeal syndrome. The first case, a 30-year-old black bisexual male, had concurrent meningeal and ocular syphilis with persistent unusually low CSF glucose levels. He responded well to 21 days of intravenous penicillin therapy. The second case was a 55-year-old female with epilepsy, depression, behavioral disorder and confusion. The diagnosis of HIV infection was made after onset of the syphilitic meningitis. She was treated with 21 days i.v. penicillin with improvement in her clinical condition. The clinical aspects of combined neurosyphilis and HIV infection, plus special features of diagnosis and treatment are discussed.

Background: Sudden limb paresis is a common problem in White Leghorn flocks, affecting about 1% of the chicken population before achievement of sexual maturity. Previously, a similar clinical syndrome has been reported as being caused by inflammatory demyelination of peripheral nerve fibres. Here, we investigated in detail the immunopathology of this paretic syndrome and its possible resemblance to human neuropathies. Methods: Neurologically affected chickens and control animals from one single flock underwent clinical and neuropathological examination. Peripheral nervous system (PNS) alterations were characterised using standard morphological techniques, including nerve fibre teasing and transmission electron microscopy. Infiltrating cells were phenotyped immunohistologically and quantified by flow cytometry. The cytokine expression pattern was assessed by quantitative real-time PCR (qRT-PCR). These investigations were accomplished by MHC genotyping and a PCR screen for Marek's disease virus (MDV). Results: Spontaneous paresis of White Leghorns is caused by cell-mediated, inflammatory demyelination affecting multiple cranial and spinal nerves and nerve roots with a proximodistal tapering. Clinical manifestation coincides with the employment of humoral immune mechanisms, enrolling plasma cell recruitment, deposition of myelinbound IgG and antibody-dependent macrophageal myelin-stripping. Disease development was significantly linked to a 539 bp microsatellite in MHC locus LEI0258. An aetiological role for MDV was excluded. Conclusions: The paretic phase of avian inflammatory demyelinating polyradiculoneuritis immunobiologically resembles the late-acute disease stages of human acute inflammatory demyelinating polyneuropathy, and is characterised by a Th1-to-Th2 shift.

Background: Sudden limb paresis is a common problem in White Leghorn flocks, affecting about 1% of the chicken population before achievement of sexual maturity. Previously, a similar clinical syndrome has been reported as being caused by inflammatory demyelination of peripheral nerve fibres. Here, we investigated in detail the immunopathology of this paretic syndrome and its possible resemblance to human neuropathies. Methods: Neurologically affected chickens and control animals from one single flock underwent clinical and neuropathological examination. Peripheral nervous system (PNS) alterations were characterised using standard morphological techniques, including nerve fibre teasing and transmission electron microscopy. Infiltrating cells were phenotyped immunohistologically and quantified by flow cytometry. The cytokine expression pattern was assessed by quantitative real-time PCR (qRT-PCR). These investigations were accomplished by MHC genotyping and a PCR screen for Marek's disease virus (MDV). Results: Spontaneous paresis of White Leghorns is caused by cell-mediated, inflammatory demyelination affecting multiple cranial and spinal nerves and nerve roots with a proximodistal tapering. Clinical manifestation coincides with the employment of humoral immune mechanisms, enrolling plasma cell recruitment, deposition of myelinbound IgG and antibody-dependent macrophageal myelin-stripping. Disease development was significantly linked to a 539 bp microsatellite in MHC locus LEI0258. An aetiological role for MDV was excluded. Conclusions: The paretic phase of avian inflammatory demyelinating polyradiculoneuritis immunobiologically resembles the late-acute disease stages of human acute inflammatory demyelinating polyneuropathy, and is characterised by a Th1-to-Th2 shift.

La neurosífilis se asocia con distintos síndromes clínicos neurológicos, en especial en enfermos con compromiso del sistema inmunitario. No obstante, la afección aislada del canal medular es poco frecuente. Se presenta una paciente inmunocompetente, con antecedentes de un parto reciente eutócico con pareja estable y sin epidemiología evidente para infecciones de transmisión sexual, que se presentó a la consulta con paraparesia asimétrica con hipoestesia agregada. Mediante pruebas complementarias se llegó al diagnóstico de neurosífilis. Se destaca la consideración de esta entidad entre los diagnósticos diferenciales del síndrome mielítico, incluso en sujetos sin alteraciones de la inmunidad.
English: Neurosyphilis is associated to various clinical neurological syndromes, especially in patients with compromise of the immunological system. Nevertheless, an isolated disease of the medullar channel is rare. We present an immunocompetent patient with a background of a recent eutocic delivery, with a stable partner, and without any epidemiological evidence of sexually transmitted diseases, who consulted due to asymmetric paraparesis with aggregated hypoesthesia. Through complementary tests a diagnosis of neurosyphilis was reached. The consideration of this entity among differential diagnoses for a myelitic syndrome is emphasized, even in subjects with no immunological alterations.