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DefinitionNeurosyphilis is a slowly progressive and destructive infection of the brain or spinal cord. It occurs in untreated syphilis many years after the primary infection.
Causes, incidence, and risk factorsNeurosyphilis occurs in 15 to 20% of all late or tertiary syphilis infections and is a progressive, life-threatening complication. There are 4 different forms of neurosyphilis: asymptomatic , meningovascular, tabes dorsalis , and general paresis .
Asymptomatic neurosyphilis precedes symptomatic syphilis and is present in 15% of those with latent (hidden) syphilis. In this case, abnormalities may be present in the cerebrospinal fluid, but no symptoms are present.
In meningovascular neurosyphilis, cranial nerve palsies and pupil abnormalities may be among a wide variety of symptoms. This may also cause damage to blood vessels resulting in stroke.
In tabes dorsalis, progressive degeneration of the spinal cord occurs causing an inability to walk.
In general paresis, paralysis , tremors , seizures , and mental decline occur as a result of damage to brain cells. Gummas (inflammatory lesions) may occur anywhere in the brain or spinal cord and can cause a wide variety of neurologic deficits.
Syphilitic aseptic meningitis occurs as a chronic infection and may involve headaches, cognitive changes and cranial nerve abnormalities.
Signs and tests
Tests to detect syphilis include detection of antibodies in blood. These are non-treponemal tests (VDRL, RPR). These are not specific and are used as screening tests. If positive the diagnosis of syphilis is confirmed using treponemal tests (e.g., FTA-Abs or MHATP). In neurosyphilis, it is important to test for VDRL in the spinal fluid.Tests to evaluate the nervous system may include:
TreatmentThe treatment of syphilis is determined by the length of time the individual has been infected. Primary, secondary or latent syphilis of less than one year duration is treated as follows:
Syphilis during pregnancy:
Follow-up blood tests must be done at 3, 6, 12, and 24 months to ensure the infection has been eliminated. There must be abstinence from sexual conduct until 2 follow-up tests have indicated that the infection has been cured. Syphilis is extremely contagious in the primary and secondary stages.
Expectations (prognosis)The outcome depends upon the type and extent of disability before treatment is begun.
Complications include a progression of symptoms.
Calling your health care providerCall for an appointment with your health care provider if neurologic symptoms develop in a person who has had syphilis in the past.
PreventionNeurosyphilis can be prevented by the timely diagnosis and treatment of primary syphilis and secondary syphilis. Good follow-up is necessary to prove a cure and prevent neurosyphilis from developing following incomplete treatment (either by inadequate medication or non-compliance of the individual taking the medication).
Update Date: 5/8/2003Elaine T. Kiriakopoulos, M.D., M.Sc., Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT