Neurosyphilis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

The late forms of neurosyphilis (tabes dorsalis and general paresis) are seen much less frequently since the advent of antibiotics. The most common manifestations today are asymptomatic or symptomatic meningitis. Clinical signs of neurosyphilis (i.e., cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities) warrant further investigation and treatment for neurosyphilis.

History and Symptoms

Asymptomatic Meningitis

• Asymptomatic neurosyphilis usually has no signs or symptoms and is diagnosed exclusively with the presence or absence of CSF abnormalities notably pleocytosis, elevated protein, decreased glucose.

Symptomatic Meningitis

• develops within 6-months to several years of primary infection
• typical meningitis symptoms: headache, nausea, vomiting, photophobia
• Acute syphilitic meningitis usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash.
• Patients present with headache, meningeal irritation, and cranial nerve abnormalities, especially the optic nerve, facial nerve, and the vestibulocochlear nerve.
• Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.

Meningovascular Syphilis

• Meningovascular syphilis occurs a few months to 10 years (average, 7 years) after the primary syphilis infection.

• Meningovascular syphilis can be associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable.

• Prodromal symptoms include:

• unilateral numbness,
• paresthesias,
• upper or lower extremity weakness,
• headache,
• vertigo,
• insomnia, and
• psychiatric abnormalities such as personality changes.

• The focal deficits initially are intermittent or progress slowly over a few days.

• However, it can also present as an infectious arteritis and cause an ischemic stroke, an outcome more commonly seen in younger patients.

• Angiography may be able to demonstrate areas of narrowing in the blood vessels or total occlusion.

Parenchymatous Neurosyphilis

• develops 15-20 years after primary infection
• argyll robertson pupil: small irregular pupil
• clinical presents as general paresis or tabes dorsalis with resultant ataxia

• General paresis, otherwise known as general paresis of the insane, is a severe manifestation of neurosyphilis.

• It is a chronic dementia which ultimately results in death in as little as 2-3 years.

• Patients generally have progressive personality changes, memory loss, and poor judgment.

• More rarely, they can have psychosis, depression, or mania.

• Imaging of the brain usually shows atrophy.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief:

Overview

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History and Symptoms

• The majority of patients with [disease name] are asymptomatic.

OR

• The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
• Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History

Patients with [disease name]] may have a positive history of:

• [History finding 1]
• [History finding 2]
• [History finding 3]

Common Symptoms

Common symptoms of [disease] include:

• [Symptom 1]
• [Symptom 2]
• [Symptom 3]

Less Common Symptoms

Less common symptoms of [disease name] include

• [Symptom 1]
• [Symptom 2]
• [Symptom 3]