neurosyphilis (dementia paralytica, syphilitic paresis)
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Introduction
Syphilis of the central nervous system.
Clinical manifestations
- slow mental deterioration
- memory loss
- impaired judgment
- irresponsibility
- psychosis & delirium in acute presentation[4]
- headaches
- tremor
- hands
- lips
- tongue
- chronic meningitis
- cranial neuropathies
- myelopathy (acute, subacute, or chronic dysfunction of the spinal cord, including tabes dorsalis)
- uveitis, visual loss, or optic nerve dysfunction
- Argyl Robertson pupil
Laboratory
- positive serologic tests for syphilis
- elevated serum globulin
- lumbar puncture
- elevated cerebrospinal fluid (CSF) pressure
- positive CSF VDRL
- CSF pleocytosis, > 20 WBC/mm3
- CSF Treponema pallidum PCR does not correlate well with CSF VDRL or CSF pleocytosis
- in HIV positive patients CD4 count < 350/mm3 predictive of neurosypilis
Complications
Management
- normal CSF:
- treat as secondary syphilis or syphilis of unknown duration
- abnormal CSF
- 12-24 million units/day of penicillin G
- given as 2-4 million units IV every 4 hours
- duration for 10-14 days
- if patients are allergic to penicillin, doxycycline 200 mg BID for 28 days is as effective as penicillin[9]
More general terms
More specific terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 878
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Journal Watch 24(6):46, 2004 Marra CM et al, J Infect Dis 189:369, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14745693
- ↑ 4.0 4.1 Knudsen RP et al Neurosyphilis, eMedicine http://emedicine.medscape.com/article/1169231-overview
- ↑ Libois A et al. HIV and syphilis: When to perform a lumbar puncture. Sex Transm Dis 2007 Mar; 34:141. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16865051
- ↑ Marra CM et al. Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: Does HIV status matter? Clin Infect Dis 2004 Apr 1; 38:1001. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15034833
- ↑ Marra CM et al. Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clin Infect Dis 2008 Oct 1; 47:893. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18715154
- ↑ Ropper AH Neurosyphilis. N Engl J Med 2019; 381:1358-1363. Oct 3, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31577877 https://www.nejm.org/doi/full/10.1056/NEJMra1906228
- ↑ 9.0 9.1 Girometti N et al. Clinical and serological outcomes in patients treated with oral doxycycline for early neurosyphilis. J Antimicrob Chemother 2021 Mar 30; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33783506 https://academic.oup.com/jac/advance-article-abstract/doi/10.1093/jac/dkab100/6202984