Criteria for the management of neurosyphilis

Dattner, Bernhard; Thomas, Evan W.; Mello, L. De

doi:10.1016/0002-9343(51)90292-6

Cited by 49 publications

(23 citation statements)

References 2 publications

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“…Neither higher drug doses nor combinations of therapies seem to prevent the development of further neurological complications. Also, our findings tend to agree with that of Wilner and Brody that progression of the disease may take place in the absence of reactive CSF tests and that some cases with persistent signs of cerebrospinal fluid activity (as indicated by Dattner, Thomas, and De Mello, 1951, and Dattner, Carmichael, De Mello, and Thomas, 1952) do not necessarily develop fresh symptoms. Hahn and others (1959) also indicated that clinical progression was unrelated to cerebrospinal fluid activity.…”

Section: Discussionsupporting

confidence: 90%

Review of hospitalized cases of general paralysis of the insane.

Dawson-Butterworth¹,

Heathcote²

1970

Sexually Transmitted Infections

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Section: Discussionsupporting

confidence: 90%

Review of hospitalized cases of general paralysis of the insane.

Dawson-Butterworth¹,

Heathcote²

1970

Sexually Transmitted Infections

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“…The CSF-VDRL titer should decline (4-fold within a year) if it is initially high, but it may take years to revert to negative (96). A per-sistent, low CSF-VDRL titer after a course of treatment may warrant retreatment, but if CSF pleocytosis and elevated protein levels have resolved and the serum VDRL titer has not risen, additional treatment is unlikely to be beneficial (97).…”

Section: Neurosyphilismentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

163

156

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bComplexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests.

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“…Entretanto, melhora significativa, ou mesmo a reversão completa dos sintomas, é pouco esperada [3][4][5] , devido a irreversível destruição dos neurônios pelo T. pallidum 3 . Dattner et al 22 relataram que somente 10% dos pacientes com a forma parética tiveram alguma melhora significativa. Alguns autores 23 têm inclusive descrito progressão do quadro, a despeito do tratamento adequado, o que poderia ser devido a cicatrizes no tecido cerebral, e não a atividade da doença.…”

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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Criteria for the management of neurosyphilis

Cited by 49 publications

References 2 publications

Review of hospitalized cases of general paralysis of the insane.

Review of hospitalized cases of general paralysis of the insane.

Recent Trends in the Serologic Diagnosis of Syphilis

Demência por neurossífilis: evolução clínica e neuropsicológica de um paciente

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