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{{Neurosyphilis}}
{{Neurosyphilis}}
{{CMG}};{{AE}}{{MMJ}}
{{CMG}};{{AE}}{{MMJ}}
==Overview==
==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]], [[altered mental status|acute or chronic altered mental status]], loss of vibration sense, and auditory or ophthalmic abnormalities) warrant further investigation and treatment for neurosyphilis.
Patients with neurosyphilis may have a positive history of unprotected sexual activity, [[HIV AIDS|HIV infection]], [[chemotherapy]], substance abuse and positive history of long-term untreated [[Syphilis|syphilis disease]]. Common symptoms of based on the classification include [[diplopia]], [[hearing loss]], [[hoarseness]],  [[headache]], [[dizziness]], [[vertigo]], [[nausea]], [[photophobia]], lightning pains, impaired [[sensation]] and [[proprioception]], [[Hypesthesia|hypesthesias]], [[hemiparesis]], homonymous [[hemianopsia]], slurred speech and [[dysarthria]]. Less common symptoms of neurosyphilis include psychosis, [[clinical depression|depression]], [[mania]] and cranial nerve abnormalities especially the [[optic nerve]], [[facial nerve]], and the [[vestibulocochlear nerve]].  
 
==History and Symptoms==
==History and Symptoms==
===Asymptomatic Meningitis===
===History===
Patients with neurosyphilis may have a positive history of:
* Unprotected sexual activity
* [[HIV AIDS|HIV infection]]
* [[Immunosuppressive therapy]]
* Substance abuse
* Positive history of long-term untreated [[Syphilis|syphilis disease]]<ref name="pmid336144">{{cite journal| author=Kolar OJ, Burkhart JE| title=Neurosyphilis. | journal=Br J Vener Dis | year= 1977 | volume= 53 | issue= 4 | pages= 221-5 | pmid=336144 | doi= | pmc=1045401 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=336144  }} </ref>


*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.<ref name="pmid20626434">{{cite journal| author=Ghanem KG| title=REVIEW: Neurosyphilis: A historical perspective and review. | journal=CNS Neurosci Ther | year= 2010 | volume= 16 | issue= 5 | pages= e157-68 | pmid=20626434 | doi=10.1111/j.1755-5949.2010.00183.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20626434 }} </ref>
=== Common Symptoms ===
 
The [[Symptom|symptoms]] of neurosyphilis usually develop secondary to long-term untreated [[syphilis]]. Common symptoms of based on the classification include:
===Symptomatic Meningitis===
* [[Cranial nerves|Cranial nerve]] dysfunction symptoms:
*Symptomatic Meningitis develops within 6-months to several years of primary infection.
** [[Diplopia]]<ref name="pmid655658">{{cite journal| author=Jordan K, Marino J, Damast M| title=Bilateral oculomotor paralysis due to neurosyphilis. | journal=Ann Neurol | year= 1978 | volume= 3 | issue= 1 | pages= 90-3 | pmid=655658 | doi=10.1002/ana.410030114 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=655658 }} </ref>
*Common symptoms of neurosyphilis [[meningitis]] include:<ref name="pmid20626434">{{cite journal| author=Ghanem KG| title=REVIEW: Neurosyphilis: A historical perspective and review. | journal=CNS Neurosci Ther | year= 2010 | volume= 16 | issue= 5 | pages= e157-68 | pmid=20626434 | doi=10.1111/j.1755-5949.2010.00183.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20626434 }} </ref><ref name="pmid336144">{{cite journal| author=Kolar OJ, Burkhart JE| title=Neurosyphilis. | journal=Br J Vener Dis | year= 1977 | volume= 53 | issue= 4 | pages= 221-5 | pmid=336144 | doi= | pmc=1045401 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=336144 }} </ref><ref name="pmid24365430">{{cite journal| author=Berger JR, Dean D| title=Neurosyphilis. | journal=Handb Clin Neurol | year= 2014 | volume= 121 | issue= | pages= 1461-72 | pmid=24365430 | doi=10.1016/B978-0-7020-4088-7.00098-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24365430 }} </ref>
**[[Impaired vision]]<ref name="pmid16397078">{{cite journal| author=Smith GT, Goldmeier D, Migdal C| title=Neurosyphilis with optic neuritis: an update. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 963 | pages= 36-9 | pmid=16397078 | doi=10.1136/pgmj.2004.020875 | pmc=2563717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16397078 }} </ref>
**[[headache]]
**[[Hearing loss]]<ref name="pmid1195972">{{cite journal| author=Nadol JB| title=Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy. | journal=Laryngoscope | year= 1975 | volume= 85 | issue= 11 pt 1 | pages= 1888-97 | pmid=1195972 | doi=10.1288/00005537-197511000-00012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1195972 }} </ref>
**[[nausea]] and vomiting
**[[Hoarseness]]<ref name="pmid24315656">{{cite journal| author=Klein TA, Ridley MB| title=An old flame reignites: vagal neuropathy secondary to neurosyphilis. | journal=J Voice | year= 2014 | volume= 28 | issue= 2 | pages= 255-7 | pmid=24315656 | doi=10.1016/j.jvoice.2013.08.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24315656 }} </ref>
**[[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|syphilis infection]].
*Meningovascular syphilis can be associated with [[prodromal]] symptoms lasting weeks to months before focal deficits are identifiable.
 
*Prodromal symptoms include:
:*Unilateral [[numbness]]
:*[[paresthesia]]s
:*upper or lower extremity weakness
:*[[headache]]
:*[[Vertigo]]
:*I[[insomnia|nsomnia]]
:*[[Psychiatric Disorders|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 [[ischemia|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:<ref name="pmid20626434" /><ref name="pmid336144" /><ref name="pmid24365430" />
*develops 15-20 years after primary infection
*[[Argyll Robertson pupil|argyll robertson pupil]]: small irregular pupil
*clinical presents as '''[[general paresis]]''' or '''[[tabes dorsalis]]''' with resultant [[ataxia]]
:*General paresis<ref name="AMN">{{cite journal | author = Richard B. Jamess, MD, PhD | title = [http://www.health.am/sex/syphilis/ Syphilis- Sexually Transmitted Infections], 2006. | journal =Sexually transmitted diseases treatment guidelines | volume = | issue = | pages = | year = 2002}}</ref>, 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.
 
:


* [[Meningitis]] symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):<ref name="pmid336144">{{cite journal| author=Kolar OJ, Burkhart JE| title=Neurosyphilis. | journal=Br J Vener Dis | year= 1977 | volume= 53 | issue= 4 | pages= 221-5 | pmid=336144 | doi= | pmc=1045401 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=336144  }} </ref><ref name="pmid26075118">{{cite journal| author=Ahsan S, Burrascano J| title=Neurosyphilis: An Unresolved Case of Meningitis. | journal=Case Rep Infect Dis | year= 2015 | volume= 2015 | issue=  | pages= 634259 | pmid=26075118 | doi=10.1155/2015/634259 | pmc=4446468 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26075118  }} </ref><ref name="pmid20626434">{{cite journal| author=Ghanem KG| title=REVIEW: Neurosyphilis: A historical perspective and review. | journal=CNS Neurosci Ther | year= 2010 | volume= 16 | issue= 5 | pages= e157-68 | pmid=20626434 | doi=10.1111/j.1755-5949.2010.00183.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20626434  }} </ref><ref name="pmid24365430">{{cite journal| author=Berger JR, Dean D| title=Neurosyphilis. | journal=Handb Clin Neurol | year= 2014 | volume= 121 | issue=  | pages= 1461-72 | pmid=24365430 | doi=10.1016/B978-0-7020-4088-7.00098-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24365430  }} </ref>
** [[Headache]]
** [[Dizziness]]
** [[Vertigo]]
** [[Nausea and vomiting]]
** [[Photophobia]]
* Symptoms of spinal cord involvement ([[Tabes Dorsalis|tabes dorsalis]]):
** Lightning pains<ref name="pmid19487174">{{cite journal| author=MAO S, LIU Z| title=Neurosyphilis manifesting as lightning pain. | journal=Eur J Dermatol | year= 2009 | volume= 19 | issue= 5 | pages= 504-6 | pmid=19487174 | doi=10.1684/ejd.2009.0712 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19487174  }} </ref>
**Impaired [[sensation]] and [[proprioception]]<ref name="pmid15224672">{{cite journal| author=Vora SK, Lyons RW| title=The medical Kipling--syphilis, tabes dorsalis, and Romberg's test. | journal=Emerg Infect Dis | year= 2004 | volume= 10 | issue= 6 | pages= 1160-2 | pmid=15224672 | doi=10.3201/eid1006.031117 | pmc=3323152 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15224672  }} </ref>
**[[Hypesthesia|Hypesthesias]]<ref name="pmid22330117">{{cite journal| author=Pandey S| title=Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. | journal=J Spinal Cord Med | year= 2011 | volume= 34 | issue= 6 | pages= 609-11 | pmid=22330117 | doi=10.1179/2045772311Y.0000000041 | pmc=3237288 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330117  }} </ref>
*Symptoms of cerebral syphilitic gumma:<ref name="pmid22167653">{{cite journal| author=Li JC, Mahta A, Kim RY, Saria M, Kesari S| title=Cerebral syphilitic gumma: a case report and review of the literature. | journal=Neurol Sci | year= 2012 | volume= 33 | issue= 5 | pages= 1179-81 | pmid=22167653 | doi=10.1007/s10072-011-0878-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22167653  }} </ref><ref name="pmid23634274">{{cite journal| author=Yoon YK, Kim MJ, Chae YS, Kang SH| title=Cerebral syphilitic gumma mimicking a brain tumor in the relapse of secondary syphilis in a human immunodeficiency virus-negative patient. | journal=J Korean Neurosurg Soc | year= 2013 | volume= 53 | issue= 3 | pages= 197-200 | pmid=23634274 | doi=10.3340/jkns.2013.53.3.197 | pmc=3638277 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23634274  }} </ref><ref name="pmid19430565">{{cite journal| author=Lee CW, Lim MJ, Son D, Lee JS, Cheong MH, Park IS et al.| title=A case of cerebral gumma presenting as brain tumor in a human immunodeficiency virus (HIV)-negative patient. | journal=Yonsei Med J | year= 2009 | volume= 50 | issue= 2 | pages= 284-8 | pmid=19430565 | doi=10.3349/ymj.2009.50.2.284 | pmc=2678706 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19430565  }} </ref>
**[[Hemiparesis]]
**[[Homonymous hemianopsia]]
**[[Slurred speech]]
**[[Dysarthria]]
The symptoms of [[Tabes Dorsalis|tabes dorsalis]] typically occurs 10 to 30 years after primary infection by [[Treponema pallidum|treponema pallidum.]]<ref name="pmid14749871">{{cite journal| author=Schöfer H| title=[Syphilis. Clinical aspects of Treponema pallidum infection]. | journal=Hautarzt | year= 2004 | volume= 55 | issue= 1 | pages= 112-9 | pmid=14749871 | doi=10.1007/s00105-003-0608-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14749871  }} </ref>
===Less Common Symptoms===
===Less Common Symptoms===
Less common symptoms of neurosyphilis include:<ref name="pmid11186166">{{cite journal| author=Kohler CG, Pickholtz J, Ballas C| title=Neurosyphilis presenting as schizophrenialike psychosis. | journal=Neuropsychiatry Neuropsychol Behav Neurol | year= 2000 | volume= 13 | issue= 4 | pages= 297-302 | pmid=11186166 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11186166  }} </ref><ref name="pmid23857843">{{cite journal| author=Wahab S, Md Rani SA, Sharis Othman S| title=Neurosyphilis and psychosis. | journal=Asia Pac Psychiatry | year= 2013 | volume= 5 Suppl 1 | issue=  | pages= 90-4 | pmid=23857843 | doi=10.1111/appy.12050 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23857843  }} </ref>
Less common symptoms of neurosyphilis include:<ref name="pmid11186166">{{cite journal| author=Kohler CG, Pickholtz J, Ballas C| title=Neurosyphilis presenting as schizophrenialike psychosis. | journal=Neuropsychiatry Neuropsychol Behav Neurol | year= 2000 | volume= 13 | issue= 4 | pages= 297-302 | pmid=11186166 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11186166  }} </ref><ref name="pmid23857843">{{cite journal| author=Wahab S, Md Rani SA, Sharis Othman S| title=Neurosyphilis and psychosis. | journal=Asia Pac Psychiatry | year= 2013 | volume= 5 Suppl 1 | issue=  | pages= 90-4 | pmid=23857843 | doi=10.1111/appy.12050 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23857843  }} </ref>
*[[psychosis]]
*[[Psychosis]]
*[[clinical depression|Depression]]
*[[clinical depression|Depression]]
*[[mania]]
*[[Mania]]
*[[Cranial nerve]] abnormalities especially the [[optic nerve]], [[facial nerve]], and the [[vestibulocochlear nerve]].


==References==
==References==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
{{CMG}}; {{AE}}
==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]
==References==
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category: (name of the system)]]

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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

Patients with neurosyphilis may have a positive history of unprotected sexual activity, HIV infection, chemotherapy, substance abuse and positive history of long-term untreated syphilis disease. Common symptoms of based on the classification include diplopia, hearing loss, hoarseness, headache, dizziness, vertigo, nausea, photophobia, lightning pains, impaired sensation and proprioception, hypesthesias, hemiparesis, homonymous hemianopsia, slurred speech and dysarthria. Less common symptoms of neurosyphilis include psychosis, depression, mania and cranial nerve abnormalities especially the optic nerve, facial nerve, and the vestibulocochlear nerve.

History and Symptoms

History

Patients with neurosyphilis may have a positive history of:

Common Symptoms

The symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis. Common symptoms of based on the classification include:

The symptoms of tabes dorsalis typically occurs 10 to 30 years after primary infection by treponema pallidum.[15]

Less Common Symptoms

Less common symptoms of neurosyphilis include:[16][17]

References

  1. ↑ 1.0 1.1 Kolar OJ, Burkhart JE (1977). "Neurosyphilis". Br J Vener Dis. 53 (4): 221–5. PMC 1045401. PMID 336144.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ Schöfer H (2004). "[Syphilis. Clinical aspects of Treponema pallidum infection]". Hautarzt. 55 (1): 112–9. doi:10.1007/s00105-003-0608-0. PMID 14749871.
  16. ↑ Kohler CG, Pickholtz J, Ballas C (2000). "Neurosyphilis presenting as schizophrenialike psychosis". Neuropsychiatry Neuropsychol Behav Neurol. 13 (4): 297–302. PMID 11186166.
  17. ↑ 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.

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