Neurology · MU Sofia

55. Neurosyphilis

Covers neurosyphilis, the nervous system infection caused by Treponema pallidum, from its definition and early versus late classification through to the named clinical forms: asymptomatic disease, syphilitic meningitis, meningovascular disease, tabes dorsalis, general paresis and Argyll Robertson pupil. It then sets out examination findings, CSF and blood tests, differential diagnoses, penicillin-based treatment and prognosis.

Inside: 1 section · 16 flashcards · 2 min

Topic 55 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 310 words (2 min of reading), with 16 flashcards.

In this note

  1. Neurosyphilis

Neurosyphilis

Definition: Neurosyphilis is an infection of the nervous system caused by Syphilis due to invasion of the CNS by Treponema pallidum. It may occur at any stage of syphilis but is most common in late disease.

Classification

A. Early Neurosyphilis: Occurs months to years after infection.

  • Forms: Asymptomatic neurosyphilis. Syphilitic meningitis. Meningovascular syphilis

B. Late Neurosyphilis: Occurs years to decades after infection.

  • Forms: Tabes dorsalis. General paresis (general paralysis of the insane).Optic atrophy

Clinical Forms

A. Asymptomatic Neurosyphilis: No neurological symptoms. Abnormal CSF findings only

B. Syphilitic Meningitis

  • Features: Headache. Neck stiffness. Cranial nerve palsies (II, VII, VIII common). Meningeal syndrome

C. Meningovascular Neurosyphilis

  • Pathology: Syphilitic arteritis → cerebral ischemia
  • Features: Stroke in relatively young patients. Hemiparesis. Aphasia. Cranial nerve deficits

D. Tabes Dorsalis (VERY IMPORTANT)

Pathology

  • Degeneration of: Posterior columns .Posterior roots
  • Clinical Features Sensory ataxia. Lightning pains (sharp shooting pains). Loss of vibration and position sense. Positive Romberg sign. Areflexia (especially knee/ankle jerks)
  • Characteristic Signs: Sensory gait ataxia. Bladder dysfunction. Charcot joints

E. General Paresis

  • Features: Progressive dementia. Personality changes. Memory loss. Emotional instability
  • Neurological signs: Dysarthria. Tremor. Hyperreflexia

Argyll Robertson Pupil

  • Features: Small irregular pupils. Accommodate but do not react to light. “Prostitute's pupil”. Accommodates but does not react

Examination Findings

  • Sensory System: Loss of proprioception. Loss of vibration sensation
  • Reflexes: Reduced/absent tendon reflexes (tabes dorsalis)
  • Coordination: Sensory ataxia. Positive Romberg
  • Mental Status: Dementia. Personality changes.

CSF Findings

  • Typical findings: Lymphocytic pleocytosis. ↑ Protein. Positive VDRL in CSF (highly specific). Positive treponemal tests

Diagnosis

  • Blood tests: VDRL/RPR (screening). FTA-ABS/TPHA (confirmatory)
  • CSF examination: CSF-VDRL (most important)

Differential Diagnosis

1.Tabes dorsalis vs Vitamin B12 deficiency: Both affect posterior columns. Syphilis serology distinguishes them

2.Dementia syndromes: Alzheimer disease. Frontotemporal dementia

3.Multiple sclerosis: Different CSF and imaging findings

Treatment

  • Drug of choice: Penicillin G (IV)
  • Alternative: Ceftriaxone (selected situations)

Prognosis: Early treatment may halt progression. Established neurological deficits may be irreversible

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