A Retrospective Study of Syphilis Seropositivity in a Cohort of Demented Patients

Powell, Artiss L.; Coyne, Andrew C.; Jen, Lian

doi:10.1097/00002093-199307010-00004

Cited by 9 publications

(11 citation statements)

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“…Except in these highincidence regions, screening for the disorder in patients with dementia without an increased pretest probability would appear to be ill-supported because positive serum Venereal Disease Research Laboratory, rapid plasma reagin, and fluorescent treponemal antibody tests are nonspecific. 146,147 Conclusions. Depression, B 12 deficiency, and hypothyroidism are comorbidities that are likely to appear in the elderly and in patients with suspected dementia in particular.…”

Section: Practice Recommendationsmentioning

confidence: 98%

Practice parameter: Diagnosis of dementia (an evidence-based review)

et al. 2001

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Article abstract-Objective: To update the 1994 practice parameter for the diagnosis of dementia in the elderly. Background: The AAN previously published a practice parameter on dementia in 1994. New research and clinical developments warrant an update of some aspects of diagnosis. Methods: Studies published in English from 1985 through 1999 were identified that addressed four questions: 1) Are the current criteria for the diagnosis of dementia reliable? 2) Are the current diagnostic criteria able to establish a diagnosis for the prevalent dementias in the elderly? 3) Do laboratory tests improve the accuracy of the clinical diagnosis of dementing illness? 4) What comorbidities should be evaluated in elderly patients undergoing an initial assessment for dementia? Recommendations: Based on evidence in the literature, the following recommendations are made.

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Section: Practice Recommendationsmentioning

confidence: 98%

Practice parameter: Diagnosis of dementia (an evidence-based review)

et al. 2001

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“…Já que a sífilis e a infecção pelo HIV estão associadas em alta proporção atualmente devido a presença de fatores de risco e vias de transmissão comuns, a infecção pelo HIV deve ser considerada em todos os pacientes com sífilis 14 . Neurossífilis também deve ser suspeitada em pacientes infectados pelo HIV com sintomas neurológicos 3,15,16 . Indivíduos co-infectados pelo HIV podem ter evidências laboratoriais e curso clínico alterado da sífilis 3,15 .…”

Section: Fig 1 Spect Cerebral Após Adminstração Endovenosa De 99m Tcunclassified

Demência por neurossífilis: evolução clínica e neuropsicológica de um paciente

Vargas¹,

Carod-Artal²,

Negro³

et al. 2000

Arq. Neuro-Psiquiatr.

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RESUMO -Demência é uma das manifestações da sífilis tardia e caracteriza-se por deterioração cognitiva e alteração do comportamento. Descrevemos um paciente com declínio cognitivo, alterações na personalidade, hiperatividade, alucinações, delírios, diminuição da capacidade de julgamento, perda da memória recente e sinal pupilar de Argyll Robertson devido a neurosífilis. O Mini Exame do Estado Mental (MEEM) foi 16. O líquido cefalorraquideano (LCR) mostrava 82 mg/dl de proteínas, 128 células/mm3 (98% mononucleares), VDRL 1:4 e hemaglutinação indireta para T. pallidum 1:2560. A ressonância magnética não mostrou alteração do encéfalo, mas o SPECT mostrou hipocaptação fronto-temporal à esquerda. O paciente apresentou melhora significativa após tratamento com penicilina endovenosa. O MEEM realizado 3 meses após o tratamento foi 22. Nova punção lombar mostrou normalização do LCR. Neurossífilis deve fazer parte do diagnóstico diferencial de todo paciente que se apresenta com deterioração cognitiva e alteração do comportamento. O Mini Exame do Estado Mental é útil na detecção das alterações cognitivas, permitindo quantificar a evolução e a resposta ao tratamento. PALAVRAS-CHAVE: neurossíflis, demência, mini-exame do estado mental. Dementia by neurosyphilis: clinical and neuropsychological follow-up of a patientABSTRACT -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 followup, MMS is an useful instrument to mesure cognitive decline and response to treatment.KEY WORDS: neurosyphilis, dementia, minimental state test.Demência era manifestação comum de acometimento do sistema nervoso central pela sífilis antes do advento da penicilina. A forma parética consistia numa das principais causas de distúrbios mentais e representava cerca de 9% das admissões de pacientes com sintomas psicóticos em hospitais psiquiátricos na primeira metade deste século 1 . Com o advento da penicilina, houve redução significativa no número de casos de sífilis, e, consequentemente, das formas terciárias 2 . Entretanto, vem se observando aumento no número de casos de sífilis na última década, o que poderá levar a aumento das formas tardias 3 . Uma das razões é a co-infecção pelo HIV, que pode acelerar o curso e alterar a resposta ao tr...

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“…Clinically, syphilis meningovascular can manifest itself by acute stroke, particularly ischemic or, more commonly, as sub acute illness, with a prodrome of weeks or months. Heubner's arteritis is the most common vasculitis in syphilis meningovascular reaching arteries of medium and large caliber, with proliferation of fibro-elastic intima, narrowing of the middle and associated fibrosis with inflammatory changes in the adventitia leading to stenosis and ectasia of the stricken vessel 8 . The second case refers to a young patient with ischemia in the area of the middle cerebral artery whose etiological investigation proved neurosyphilis.…”

Section: Relato De Casomentioning

confidence: 99%

“…The second case refers to a young patient with ischemia in the area of the middle cerebral artery whose etiological investigation proved neurosyphilis. The middle cerebral artery branches are the most often affected, but any vascular territory in the brain or in the spinal cord can be stricken 5,7,8,15 . The diagnosis is established by lying inflammatory CSF with positive serological results for syphilis.…”

Section: Relato De Casomentioning

confidence: 99%

“…Moreover, "neurorecurrence", which is the development of symptomatic infection of the CNS after standard treatment for early syphilis 2,3,6 , has been reported. Early development of tertiary manifestations has been suggested 8 . The prevalence of neurosyphilis in HIVinfected patients with late latency syphilis is estimated in 9.1% to 23.5% 9 .…”

Section: Introductionmentioning

confidence: 99%

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Neurosyphilis and Clinical Variants

Moro¹,

Bresciani²,

Oliveira³

et al. 2012

Rev Neurocienc

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Introduction. Neurosyphilis is an uncommon manifestation of central nervous system (CNS) infection caused by Treponema pallidum. Cases. We report three cases of neurosyphilis. Case 1 presented with ocular involvement: right optic atrophy and left optic neuritis; case 2 had a meningovascular form, with ischemic stroke; and case 3, a meningeal form, presented with headaches as the main complaint. Discussion. The cases reported had distinguished forms of neurosyphilis. Serologic diagnosis depends on the presence of antibodies: Veneral Disease Research Laboratory (VDRL) -not specific -and/ or Fluorescent Treponemal Antibody Absorption (FTA-ABS) -specific. Conclusion. In the cases above cerebrospinal fluid FTA-ABS was a diagnostic clue for neurosyphilis even though unreactive serum VDRL was found.

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A Retrospective Study of Syphilis Seropositivity in a Cohort of Demented Patients

Cited by 9 publications

References 0 publications

Practice parameter: Diagnosis of dementia (an evidence-based review)

Practice parameter: Diagnosis of dementia (an evidence-based review)

Demência por neurossífilis: evolução clínica e neuropsicológica de um paciente

Neurosyphilis and Clinical Variants

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