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    Neurosyphilis: Mandell: Principles and Practice of Infectious Disease, 5 Ed, PP 2476-2489. Uptodate 2002

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    Drashua Ashua
    Neurosyphilis can present in several forms including: 1. Asymptomatic neurosyphilis which is diagnosed by a positive CSF VDRL and lymphocytic pleocytosis on LP. 2. Acute syphilitic meningitis which causes symptoms like headache, fever and cranial nerve palsies. 3. Meningovascular syphilis which causes stroke-like symptoms from syphilitic endarteritis. 4. General paresis and Tabes dorsalis which are rare chronic forms causing personality changes, gait abnormalities, and spinal cord involvement, respectively.

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    Neurosyphilis: Mandell: Principles and Practice of Infectious Disease, 5 Ed, PP 2476-2489. Uptodate 2002

    Uploaded by

    Drashua Ashua
    15 views1 page
    Neurosyphilis can present in several forms including: 1. Asymptomatic neurosyphilis which is diagnosed by a positive CSF VDRL and lymphocytic pleocytosis on LP. 2. Acute syphilitic meningitis which causes symptoms like headache, fever and cranial nerve palsies. 3. Meningovascular syphilis which causes stroke-like symptoms from syphilitic endarteritis. 4. General paresis and Tabes dorsalis which are rare chronic forms causing personality changes, gait abnormalities, and spinal cord involvement, respectively.

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    Neurosyphilis can present in several forms including: 1. Asymptomatic neurosyphilis which is diagnosed by a positive CSF VDRL and lymphocytic pleocytosis on LP. 2. Acute syphilitic meningitis which causes symptoms like headache, fever and cranial nerve palsies. 3. Meningovascular syphilis which causes stroke-like symptoms from syphilitic endarteritis. 4. General paresis and Tabes dorsalis which are rare chronic forms causing personality changes, gait abnormalities, and spinal cord involvement, respectively.

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    15 views1 page

    Neurosyphilis: Mandell: Principles and Practice of Infectious Disease, 5 Ed, PP 2476-2489. Uptodate 2002

    Uploaded by

    Drashua Ashua
    Neurosyphilis can present in several forms including: 1. Asymptomatic neurosyphilis which is diagnosed by a positive CSF VDRL and lymphocytic pleocytosis on LP. 2. Acute syphilitic meningitis which causes symptoms like headache, fever and cranial nerve palsies. 3. Meningovascular syphilis which causes stroke-like symptoms from syphilitic endarteritis. 4. General paresis and Tabes dorsalis which are rare chronic forms causing personality changes, gait abnormalities, and spinal cord involvement, respectively.

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    CSC Sep-02

    Neurosyphilis
    Mandell: Principles and Practice of Infectious Disease, 5Th ed, pp 2476-2489. UptoDate 2002.

    Key Points: Symptomatic neurosyphilis may be acute (acute syphilitic meningitis) or late/chronic, which includes both meningovascular syphilis and parenchymal neurosyphilis (general paresis and/or tabes dorsalis) To make things even more confusing, there may be overlap between syndromes of meningovascular and parenchymal neurosyphilis Most forms of CNS syphilis should generate CSF with a lymphocytosis and elevated protein HIV+ patients with syphilis may have discordance between their clinical illness and syphilis serologies I. Asymptomatic neurosyphilis: 15-40% of patients with syphilis will have some CSF abnormalities Diagnosed by positive CSF VDRL; serum treponemal and non-treponemal tests usually positive as well LP: 10-100 WBC (lymphocyte predominance), protein 50-100 Rarely CSF VDRL will be negative with positive serum tests; in that case, if the patient has a CSF consistent with syphilis, many people will treat for neurosyphilis

    II. Acute syphilitic meningitis: 6% of syphilis patients Typically the earliest manifestation of neurosyphilis Often associated with cranial nerve palsies, fever, HA, meningismus, and may have signs of cortical involvement CSF may be much like asymptomatic neurosyphilis or may demonstrate higher cell counts/protein and lower glucose Serum and CSF VDRL almost always positive III. Meningovascular syphilis: 10-12% of patients Syphilitic endarteritis causes infarction clinically similar to stroke, although may have a prodrome CSF: lymphocytosis, elevated protein; CSF VDRL usually positive IV. General paresis: Relatively rare; occurs 15-20 years after initial infection Syphilitic infection of the meninges and cortex causes personality changes, paranoia, emotional lability, eventually progressing to memory loss and dementia CSF: elevated lymphs and/or protein; VDRL usually positive in pre-HIV era but current data suggests sensitivity of 27-92%. Treponemal tests may be more sensitive but often are not standardized for use on CSF. A PCR has been developed but data on utility not known. V. Tabes dorsalis: Now rare; disease of posterior columns of spinal cord that occurs 18-25 years after infection. Often coexists with general paresis. Manifestations: abnormal gait, paresthesias, lightning pains of extremities, loss of proprioception on exam, positive Romberg; Argyll-Robertson pupils may be seen with this and/or general paresis Abnormal CSF is less common in this setting, and CSF VDRL was normal in up to 1/3 of cases in preHIV era VI. Pearls about neurosyphilis: Any inflammatory disease of the eye can be mimicked by neurosyphilis The cranial nerves most commonly involved in neurosyphilis are VII and VIII Syphilitic otitis causes tinnitus and may be the only symptom at presentation In non-HIV+ patients, those with neurosyphilis should have a positive serum treponemal test (MHATP/FTA) In non-HIV+ patients, a positive CSF VDRL always indicates neurosyphilis, whereas a positive CSF PCR for syphilis simply indicates that CSF invasion has occurred HIV+ patients may have titers discordant from their true disease state and therefore probably warrant more aggressive treatment; they may also progress more quickly than pts in the pre-HIV era

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