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

History

Patients with neurosyphilis may have a positive history of:

• Unprotected sexual activity
• HIV infection
• Immunocompromised state
• Immunosuppressive therapy
• Substance abuse
• Positive history of long-term untreated syphilis disease

Common Symptoms

The common symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis, and include:

• Cranial nerve dysfunction symptoms:
  • Diplopia
  • Impaired vision
  • Hearing loss
  • Voice changes

• Meningitis symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):
  • Persistent headache
  • Dizziness
  • Vertigo
  • nausea and vomiting
  • photophobia
  • cranial nerve abnormalities especially the optic nerve, facial nerve, and the vestibulocochlear nerve.
• Symptoms of spinal cord involvement (tabes dorsalis):
  • Lightning pains
  • Impaired sensation and proprioception
  • Hypesthesias
• Symptoms of cerebral syphilitic gumma:
  • Hemiparesis
  • Homonymous hemianopsia
  • Slurred speech
  • Dysarthria

The symptoms of tabes dorsalis typically occurs 10 to 30 years after primary infection by treponema pallidum.

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.

Less Common Symptoms

Less common symptoms of neurosyphilis include:

• psychosis
• Depression
• mania