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
The symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis, and include:
- Cranial nerve dysfunction symptoms:
- Diplopia[1]
- Impaired vision[2]
- Hearing loss[3]
- Voice changes[4]
- Meningitis symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):[5]
- Symptoms of spinal cord involvement (tabes dorsalis):
- Lightning pains[6]
- Impaired sensation and proprioception[7]
- Hypesthesias[8]
- Symptoms of cerebral syphilitic gumma:[9][10][11]
The symptoms of tabes dorsalis typically occurs 10 to 30 years after primary infection by treponema pallidum.[12]
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.[13]
Symptomatic Meningitis
- Symptomatic Meningitis develops within 6-months to several years of primary infection.
- Common symptoms of neurosyphilis meningitis include:[13][14][15]
- headache
- nausea and vomiting
- photophobia
- cranial nerve abnormalities especially the optic nerve, facial nerve, and the vestibulocochlear nerve.
- Acute syphilitic meningitis usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash.
- 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
- 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
Common features of parenchymatous Neurosyphilis include:[13][14][15]
- 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[16], 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.
Less Common Symptoms
Less common symptoms of neurosyphilis include:[17][18]
References
- ↑ Jordan K, Marino J, Damast M (1978). "Bilateral oculomotor paralysis due to neurosyphilis". Ann Neurol. 3 (1): 90–3. doi:10.1002/ana.410030114. PMID 655658.
- ↑ Smith GT, Goldmeier D, Migdal C (2006). "Neurosyphilis with optic neuritis: an update". Postgrad Med J. 82 (963): 36–9. doi:10.1136/pgmj.2004.020875. PMC 2563717. PMID 16397078.
- ↑ Nadol JB (1975). "Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy". Laryngoscope. 85 (11 pt 1): 1888–97. doi:10.1288/00005537-197511000-00012. PMID 1195972.
- ↑ Klein TA, Ridley MB (2014). "An old flame reignites: vagal neuropathy secondary to neurosyphilis". J Voice. 28 (2): 255–7. doi:10.1016/j.jvoice.2013.08.018. PMID 24315656.
- ↑ Ahsan S, Burrascano J (2015). "Neurosyphilis: An Unresolved Case of Meningitis". Case Rep Infect Dis. 2015: 634259. doi:10.1155/2015/634259. PMC 4446468. PMID 26075118.
- ↑ MAO S, LIU Z (2009). "Neurosyphilis manifesting as lightning pain". Eur J Dermatol. 19 (5): 504–6. doi:10.1684/ejd.2009.0712. PMID 19487174.
- ↑ Vora SK, Lyons RW (2004). "The medical Kipling--syphilis, tabes dorsalis, and Romberg's test". Emerg Infect Dis. 10 (6): 1160–2. doi:10.3201/eid1006.031117. PMC 3323152. PMID 15224672.
- ↑ Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
- ↑ Li JC, Mahta A, Kim RY, Saria M, Kesari S (2012). "Cerebral syphilitic gumma: a case report and review of the literature". Neurol Sci. 33 (5): 1179–81. doi:10.1007/s10072-011-0878-8. PMID 22167653.
- ↑ Yoon YK, Kim MJ, Chae YS, Kang SH (2013). "Cerebral syphilitic gumma mimicking a brain tumor in the relapse of secondary syphilis in a human immunodeficiency virus-negative patient". J Korean Neurosurg Soc. 53 (3): 197–200. doi:10.3340/jkns.2013.53.3.197. PMC 3638277. PMID 23634274.
- ↑ Lee CW, Lim MJ, Son D, Lee JS, Cheong MH, Park IS; et al. (2009). "A case of cerebral gumma presenting as brain tumor in a human immunodeficiency virus (HIV)-negative patient". Yonsei Med J. 50 (2): 284–8. doi:10.3349/ymj.2009.50.2.284. PMC 2678706. PMID 19430565.
- ↑ Schöfer H (2004). "[Syphilis. Clinical aspects of Treponema pallidum infection]". Hautarzt. 55 (1): 112–9. doi:10.1007/s00105-003-0608-0. PMID 14749871.
- ↑ 13.0 13.1 13.2 Ghanem KG (2010). "REVIEW: Neurosyphilis: A historical perspective and review". CNS Neurosci Ther. 16 (5): e157–68. doi:10.1111/j.1755-5949.2010.00183.x. PMID 20626434.
- ↑ 14.0 14.1 Kolar OJ, Burkhart JE (1977). "Neurosyphilis". Br J Vener Dis. 53 (4): 221–5. PMC 1045401. PMID 336144.
- ↑ 15.0 15.1 Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Richard B. Jamess, MD, PhD (2002). "Syphilis- Sexually Transmitted Infections, 2006". Sexually transmitted diseases treatment guidelines. External link in
|title=(help) - ↑ Kohler CG, Pickholtz J, Ballas C (2000). "Neurosyphilis presenting as schizophrenialike psychosis". Neuropsychiatry Neuropsychol Behav Neurol. 13 (4): 297–302. PMID 11186166.
- ↑ Wahab S, Md Rani SA, Sharis Othman S (2013). "Neurosyphilis and psychosis". Asia Pac Psychiatry. 5 Suppl 1: 90–4. doi:10.1111/appy.12050. PMID 23857843.
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]