Neurosyphilis in the modern era: Literature review and case series

Skalnaya, Anastasia A.; Fominykh, Vera; Ivashchenko, R.; Averchenkov, D.; Grazhdantseva, L.; Frigo, N V; Negasheva, E.S.; Dolya, O. V.; Brylev, Lev; Guekht, Alla

doi:10.1016/j.jocn.2019.08.033

Cited by 40 publications

(33 citation statements)

References 31 publications

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“…The portions of neuraxis that get involved by NS today have remained the same as traditionally described, but the symptoms are varied and are different from the traditional descriptions. [ 2 3 4 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] Our degree of suspicion for NS is low, and other alternative causes of such presentations which are common are initially thought of in the workup. [ 2 4 5 ] We present our experience to describe features of NS in the present era, the alternative differential diagnoses we thought of, and the process as to how the diagnosis was reached.…”

Section: Introductionmentioning

confidence: 99%

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Neurosyphilis, A True Chameleon of Neurology

Pujari

Kulkarni

Duberkar

et al. 2021

Annals of Indian Academy of Neurology

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Background: Neurosyphilis (NS) is a rarely encountered scenario today. Manifestations are heterogeneous, and their characteristics have changed in the antibiotic era. A differential diagnosis of NS is not commonly thought of even with relevant clinical-radiological features, as it mimics many common neurological syndromes. Objectives: To study the manifestations of NS in the present era and the process of diagnosis. Method: The data of ten patients with NS was collected and analyzed. Their background data, clinical features, investigations, the process of reaching the diagnosis, management and outcomes were recorded. Observations and Results: The manifestations of NS in our cohort included six patients with cognitive decline/encephalopathy and one each with meningitis with cranial nerve palsies, cerebellar ataxia, myelitis and asymptomatic NS. The presence of Argyll Robertson pupil helped to clinch diagnosis in one patient. Treponemal tests were ordered in two patients only after alternative etiologies were looked at, to begin with, whereas in six patients treponemal test was requested as a part of standard workup for dementia/ataxia. Conclusions: NS dementia and behavior changes are mistaken for degenerative, vascular, nutritional causes, autoimmune encephalitis or prion disease. Meningitis has similarities with infective (tubercular), granulomatous (sarcoidosis, Wegener's), collagen vascular disease and neoplastic meningitis, and myelitis simulates demyelination or nutritional myelopathy (B 12 deficiency). Rarely, NS can also present with cerebellar ataxia. Contemplate NS as one of the rare causes for such syndromes, and its early treatment produces good outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurosyphilis, A True Chameleon of Neurology

Pujari

Kulkarni

Duberkar

et al. 2021

Annals of Indian Academy of Neurology

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“… 1 The presentation of neurosyphilis varies depending on the involved CNS site; with respect to temporality, early symptomatic forms include meningeal and meningovascular syphilis, and the late forms include tabes dorsalis and general paresis. 1 , 2 Ischemic stroke from meningovascular syphilis is uncommon; however, it is modifiable with early recognition and treatment. This case report described an ischemic stroke caused by meningovascular syphilis with literature review.…”

Section: Introductionmentioning

confidence: 99%

Neurosyphilis Presenting as the Lateral Medullary Syndrome

Riffel

2022

kjm

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“…Neurosyphilis may be asymptomatic or have an atypical clinical picture, therefore, a careful differential diagnosis is needed. Late stages of syphilis with damage of the nervous system can be formed on the basis of latent syphilitic infection; the timely diagnosis of it depends on the effectiveness of laboratory methods [7].…”

Section: Introductionmentioning

confidence: 99%

Special aspects of the course and diagnosis of neurosyphilis on the example of a clinical case

2021

Actual Problems of Modern Medicine

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Neurosyphilis is an infectious disease caused by Treponema pallidum and characterized by damage of the central nervous system. This disease may be asymptomatic or have an atypical clinical course, which leads to late diagnosis. The most informative diagnostic methods for this disease are specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis. Aim. To show the features of the course, treatment and diagnosis of neurosyphilis using the example of a clinical case. Materials and methods. Patient S., born in 1963, complained about significant memory impairment, difficulties with orientation in time and space, mood swings, verbosity and exaggeration, and was hospitalized at the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”. Neurological status: eye slits and pupils were uniform. The movements of the eyeballs were painless. Insufficiency of the act of convergence was found. Corneal reactions were reduced. The patient felt pain after the palpation of supra- and infraorbital points. There was an asymmetry in the facial innervation. The tongue was on the midline, swollen, with tooth imprints. There were no pathological signs, sensitive violations. Shaking movements were noticed during the Romberg test. During the examination of the cognitive function using the Mini-Mental State Examination (MMSE) scale, the patient scored 21 points, which corresponds to mild dementia. Results. 1. According to the results of MRI examination of the brain, there was an MR-picture of areas of cystic-gliosis transformation of the poles of the temporal lobes and structural changes of the hippocampal gyrus (most likely, caused by the chronic inflammatory process); vascular foci of the brain as manifestations of dyscirculatory changes, moderate external hydrocephalus. 2. A serological examination for the presence of the antigen of the Treponema pallidum pathogen was performed, the result was positive. 3. Cerebrospinal fluid analysis revealed the following results. Cytosis was 1x106/l, protein was 0.21 g/l, glucose 3.4 mmol/l, Pandy test positivity. Based on the obtained data, the patient was diagnosed with neurosyphilis. The patient underwent etiopathogenetic treatment with benzylpenicillin sodium. After treatment the patient's condition gradually improved. Conclusions. Specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis are mandatory tests for the diagnosis of neurosyphilis. Early detection of Treponema pallidum and rational therapy can prevent the development of severe consequences and improve the patient's condition. Syphilis is a multidisciplinary problem today and needs the attention of general practitioners, dermatologists and neurologists.

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Neurosyphilis in the modern era: Literature review and case series

Cited by 40 publications

References 31 publications

Neurosyphilis, A True Chameleon of Neurology

Neurosyphilis, A True Chameleon of Neurology

Neurosyphilis Presenting as the Lateral Medullary Syndrome

Special aspects of the course and diagnosis of neurosyphilis on the example of a clinical case

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