Neurocognitive and psychiatric changes as the initial presentation of neurosyphilis

Abstract

Despite its recognition for centuries as "the great imitator," neurosyphilis re mains a diagnostic challenge because of its wide spectrum of presentations. Here we describe 3 men with neurosyphilis in whom diagnosis and treatment were delayed for up to a year because their initial presentations were in keeping with primary neurological or psychiatric problems. CasesCase 1 A 40-year-old heterosexual man was admitted to a psychiatric ward with a 2-3 week history of excessive talking with senseless conversation, excessive activity, decreased sleep and delusions of grandiosity. The patient had been well previously other than having depression more than 10 years earlier and chronic back pain. Bipolar disorder with manic episode was diagnosed.Investigations included magnetic resonance imaging (MRI), which showed mineral deposits within the globus pallidus ( Figure 1); however, screening for Wilson disease was negative. Further work-up included measurement of iron, ferritin, thyroid-stimulating hormone, vitamin B 12 and folate levels, all of which were within normal limits. Results of toxicology and serologic HIV testing were also negative.Upon admission, the patient received treatment with lithium and olanzapine, as well as temporary sedation with clonazepam. Over the next few months, a mask-like facies developed, his speech became slow and stuttered, and a tremor developed in his right hand. The patient had reduced strength, and his deep tendon reflexes were brisk on the right side. His gate was shuffling, and he had difficulty with turning.The development of neurologic symptoms prompted serologic testing for syphilis. Enzyme immunoassay was positive for antibodies to Treponema pallidum, the T. pallidum particle agglutination assay was reactive, and the rapid plasma reagin test was reactive with a titre of 1:128. Subsequent analysis of the cerebrospinal fluid (CSF) showed a leukocyte count of 42 (normal < 5) × 10 6 /L with 91% lymphocytes, a protein level of 1.43 (normal 0.15-0.45) g/L and a Venereal Disease Research Laboratory (VDRL) titre of 1:4 with a reactive T. pallidum particle agglutination assay. The patient indicated having 2 previous female sexual partners, and there was Cases

Diagnostic Challenges Arising from Neuropsychiatric Manifestations of Syphilis: Insights from 11 Clinical Cases

“…Th ere are many case reports that underline the fact that appropriate treatment may be delayed due to nonspecifi c psychiatric symptoms. For instance, Costiniuk and MacPherson eported 3 patients who presented with sleep disturbances, psychosis, hyperactivity, seizures, cognitive impairment, lower-limb weakness and dysarthria 5,6 .…”

Atypical behavioral and psychiatric symptoms: neurosyphilis should always be considered

“…4 Neurosyphilis (NS) occurs in up to 30% of people with untreated syphilis and may occur at any stage of the infection. 5 Although a decline in the incidence and prevalence of syphilis has been considered as its continuing trend, currently, an increase in new cases of the disease points to the contrary. Meanwhile, the clinical presentation of NS has been changing.…”

Atypical Case of Neurosyphilis

“…Alzheimer, hipofiz tümörü, kafa travmaları, serebrovasküler hastalık, Parkinson hastalığı ve AIDS ile birlikte görülebilmektedir. [17][18][19] Olgumuzda idrar inkontinansı, sık idrara çıkma yakınmasıyla yapılan dolum sistometrisinde mesanede orta düzeyde kompliyans kaybı, basınç akım çalışmasında hiposensitivite, hipokompliyans, akontraktil mesane saptandı. Mesane disfonksiyonu nörosifilizde nadir olmakla birlikte görüle-bilmektedir.…”

“…Mesane disfonksiyonu nörosifilizde nadir olmakla birlikte görüle-bilmektedir. 19 Nörosifilize bağlı nörojen mesane tanısıyla temiz aralıklı kateterizasyon, oral antikolinerjik tedavi başlandı.…”