Neurosyphilis and psychosis

Wahab, Suzaily; Rani, Shahrul Azmin Md.; S, Othman

doi:10.1111/appy.12050

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…1 The Paraneoplastic Neurological Syndrome Euronetwork has identified 4 criteria for the diagnosis of paraneoplastic LE, all of which must be met: clinical features, involvement of the limbic system on the basis of neuroimaging and neuropathologic findings, absence of other possible pathologies of limbic dysfunction, evidence of a cancer within 5 years of the diagnosis of the neurological symptoms or development of classic symptoms of limbic dysfunction in association with paraneoplastic antibodies. 1,18 The absence of paraneoplastic serological markers and exclusion of cancer support our diagnosis in the case described here.…”

Section: Discussionsupporting

confidence: 76%

“…Thus, the classic form of the illness (tabe dorsalis, general paresis, meningovascular, meningeal) is rarely seen, and it may manifest itself in other atypical clinical forms. 12,18,19 Penicillin G is still the first-line treatment for neurosyphilis, but ceftriaxone 2 g intravenously once per day for 10 to 14 days or doxycycline 200 mg orally 2 times/day for 28 days may be acceptable alternatives. 20 Data on the treatment of psychiatric symptoms associated with neurosyphilis are limited.…”

Section: Discussionmentioning

confidence: 99%

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A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

Toffanin

Miola

Follador

et al. 2019

Journal of Psychiatric Practice

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Limbic encephalitis is an inflammatory process of the limbic structures, with polymorphic clinical features, caused by paraneoplastic and nonparaneoplastic conditions and infections. We describe a case of neurosyphilis limbic encephalitis, presenting with reversible Geschwind syndrome (hyperreligiosity and hypergraphia) and mood disorder due to the predominant involvement of left mesial temporal structures in a previously healthy 34-year-old, left-handed woman. Because neurosyphilis can mimic common neuropsychiatric syndromes, it should be included in the differential diagnosis of psychiatric disorders with suspected general medical causes. This case of nondominant limbic encephalopathy caused by syphilis infection highlights the relevance of a careful investigation for secondary psychotic, mood, and personality disorders when assessing new-onset psychiatric illness and the importance of a multidisciplinary approach to provide a better outcome in patients with neurosyphilis.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

Toffanin

Miola

Follador

et al. 2019

Journal of Psychiatric Practice

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“…In a case report documenting a 40-year-old male positive for neurosyphilis, antipsychotic treatment was attempted but was not found to be a beneficial measure [9]. However, in another case report 400 mg of valproate twice a day was used to reduce agitation symptoms effectively [10]. Of note, in the latter case study, penicillin was not effective in completely clearing the patient of psychotic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis Presenting as Intermittent Explosive Disorder and Acute Psychosis

Saini

Sayre

Saini

et al. 2019

Cureus

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We present a case of a patient with tertiary syphilis, manifesting as acute psychosis, auditory hallucinations and intermittent explosive disorder with pending legal ramifications for physical violence. Our patient had been seen and treated by a psychologist with Aripiprazole for his erratic and aggressive behavior coupled with his new found psychosis over a one-year period with no avail. Prior accounts of interaction with the patient described him as "easy going", "laid back", and cooperative. Our patient had a complete return to baseline mentation and functionality post treatment with 4 Million Units every four hours of penicillin for two weeks. Neurosyphilis is a disease that greatly affects the mental functioning capacity of those infected. While treatment of syphilis has become greatly straightforward, those living in impoverished conditions and without a continual access to the health care system can progress through the stages of syphilis. It is of vital importance to keep syphilis on our differential for patients with rapidly progressing and broadly encompassing psychiatric disturbances especially in patients that have a lower socioeconomic status.

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“…Our findings suggest that in patients with non-specific neurological symptoms and psychotic disorders, neuroimaging can play an important role in indicating suspicion of encephalitis [ 7 ]. Enhancement of anterior parts of the temporal lobe is an atypical imaging finding, which can simulate an infection with herpes simplex virus, which is also the most common differential diagnosis of syphilitic encephalitis [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

et al. 2022

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Patient: Male, 49-year-old Final Diagnosis: Neurosyphilis Symptoms: Behavioral disturbance • confusion • disorientation • hallucinations • memory loss Medication: Penicillin G • acyclovir Clinical Procedure: Lumbar puncture Specialty: Infectious Diseases • Neurology • Radiology Objective: Rare disease Background: Neurosyphilis is a central nervous system infection caused by Treponema pallidum , that can develop at any time after the initial infection. The clinical signs of neurosyphilis are very variable, as well as its radiological features, and it is a diagnostic challenge. Knowledge of clinical symptoms and correct laboratory diagnostics, combined with routine radiological examination and additional diagnostic tools, such as high-resolution, three-dimensional FLAIR sequence, T2-weighted, and T1-weighted contrast-enhanced magnetic resonance imaging (MRI) are key to making an accurate diagnosis of neurosyphilis. Case Report: We present the clinical case of a patient who presented a 1-year history of vague clinical symptoms and was misdiagnosed with herpes simplex virus (HSV) encephalitis. Initial head MRI revealed extensive cerebral white matter lesions with cortical contrast enhancement, mainly of anterior and medial parts of the left temporal lobe, as typically seen in HSV encephalitis. Empirical therapy with acyclovir was started until a diagnosis of syphilis was confirmed with laboratory findings. Later, the therapy was changed to penicillin G. The patient’s condition improved after receiving targeted treatment. A control MRI scan was performed, and previously detected changes in the brain had decreased significantly. Conclusions: MRI is the imaging of choice to support the diagnosis of neurosyphilis. Our findings suggest that neuroimaging can play an important role in indicating suspicion of syphilitic encephalitis. Enhancement of the anterior and medial parts of the temporal lobe is an atypical imaging finding, and it can simulate an infection with HSV. Early treatment is critical to a positive outcome.

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Neurosyphilis and psychosis

Cited by 6 publications

References 12 publications

A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

Neurosyphilis Presenting as Intermittent Explosive Disorder and Acute Psychosis

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

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