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| ==History and Symptoms== | | ==History and Symptoms== |
| ===History=== | | ===History=== |
| Patients with tabes dorsalis may have a positive history of: | | Patients with neurosyphilis may have a positive history of: |
| * Unprotected sexual activity | | * Unprotected sexual activity |
| * HIV infection | | * HIV infection |
| * [[Immunocompromised]] state | | * [[Immunocompromised]] state |
| * [[Immunosuppressive therapy]] | | * [[Immunosuppressive therapy]] |
| * Substance abuse | | * [[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> | | * Positive history of long-term untreated [[Syphilis|syphilis disease]] |
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| The [[Symptom|symptoms]] of neurosyphilis usually develop secondary to long-term untreated [[syphilis]], and include: | | === Common Symptoms === |
| | The common [[Symptom|symptoms]] of neurosyphilis usually develop secondary to long-term untreated [[syphilis]], and include: |
| * [[Cranial nerves|Cranial nerve]] dysfunction symptoms: | | * [[Cranial nerves|Cranial nerve]] dysfunction symptoms: |
| ** [[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> | | ** [[Diplopia]] |
| **[[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> | | **[[Impaired vision]] |
| **[[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> | | **[[Hearing loss]] |
| **Voice changes<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> | | **Voice changes |
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| * [[Meningitis]] symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):<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> | | * [[Meningitis]] symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):<ref name="pmid336144" /><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> |
| ** Persistent headache | | ** [[Headache|Persistent headache]] |
| ** [[Dizziness]] | | ** [[Dizziness]] |
| ** [[Vertigo]] | | ** [[Vertigo]] |
| | **[[nausea]] and vomiting |
| | **[[photophobia]] |
| | **[[cranial nerve]] abnormalities especially the [[optic nerve]], [[facial nerve]], and the [[vestibulocochlear nerve]]. |
| * Symptoms of spinal cord involvement ([[Tabes Dorsalis|tabes dorsalis]]): | | * 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> | | ** Lightning pains |
| **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> | | **Impaired [[sensation]] and [[proprioception]] |
| **[[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> | | **[[Hypesthesia|Hypesthesias]] |
| *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> | | *Symptoms of cerebral syphilitic gumma: |
| **[[Hemiparesis]] | | **[[Hemiparesis]] |
| **[[Homonymous hemianopsia]] | | **[[Homonymous hemianopsia]] |
| **[[Slurred speech]] | | **[[Slurred speech]] |
| **[[Dysarthria]] | | **[[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> | | The symptoms of [[Tabes Dorsalis|tabes dorsalis]] typically occurs 10 to 30 years after primary infection by [[Treponema pallidum|treponema pallidum.]] |
| ===Asymptomatic Meningitis=== | | ======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.<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>
| |
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| ===Symptomatic Meningitis===
| |
| *Symptomatic Meningitis develops within 6-months to several years of primary infection.
| |
| *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>
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| **[[headache]]
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| **[[nausea]] and vomiting
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| **[[photophobia]]
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| **[[cranial nerve]] abnormalities especially the [[optic nerve]], [[facial nerve]], and the [[vestibulocochlear nerve]].
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| *Acute syphilitic [[meningitis]] usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash.
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| *Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.
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| ===Meningovascular Syphilis===
| | *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. |
| | |
| *Meningovascular syphilis occurs a few months to 10 years (average, 7 years) after the primary [[Syphilis|syphilis infection]]. | |
|
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| *Meningovascular syphilis can be associated with [[prodromal]] symptoms lasting weeks to months before focal deficits are identifiable.
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| *Prodromal symptoms include:
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| :*Unilateral [[numbness]]
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| :*[[paresthesia]]s
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| :*upper or lower extremity weakness
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| :*[[headache]]
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| :*[[Vertigo]]
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| :*I[[insomnia|nsomnia]]
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| :*[[Psychiatric Disorders|Psychiatric abnormalities]] such as [[personality changes]]
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| *The focal deficits initially are intermittent or progress slowly over a few days.
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| *However, it can also present as an infectious [[arteritis]] and cause an [[ischemia|ischemic]] [[stroke]], an outcome more commonly seen in younger patients.
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| *[[Angiography]] may be able to demonstrate areas of narrowing in the blood vessels or total occlusion.
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| ===Parenchymatous Neurosyphilis===
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| Common features of parenchymatous Neurosyphilis include:<ref name="pmid20626434" /><ref name="pmid336144" /><ref name="pmid24365430" />
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| *develops 15-20 years after primary infection
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| *[[Argyll Robertson pupil|argyll robertson pupil]]: small irregular pupil
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| *clinical presents as '''[[general paresis]]''' or '''[[tabes dorsalis]]''' with resultant [[ataxia]]
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| :*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.
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| :*It is a chronic [[dementia]] which ultimately results in death in as little as 2-3 years.
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| :*Patients generally have progressive personality changes, memory loss, and poor judgment.
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| :
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| ===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: |
| *[[psychosis]] | | *[[psychosis]] |
| *[[clinical depression|Depression]] | | *[[clinical depression|Depression]] |
| *[[mania]] | | *[[mania]] |
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| ==References==
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| {{Reflist|2}}
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| [[Category:Needs content]] | | [[Category:Needs content]] |
| [[Category:Disease]] | | [[Category:Disease]] |
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| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Sexually transmitted diseases]] | | [[Category:Sexually transmitted diseases]] |
| {{WH}}
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| {{WS}}
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| {{CMG}}; {{AE}}
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| ==Overview==
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| The majority of patients with [disease name] are asymptomatic.
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|
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| OR
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|
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| 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].
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|
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| ==History and Symptoms==
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| *The majority of patients with [disease name] are asymptomatic.
| |
| OR
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| *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].
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| *Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
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| ===History===
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| Patients with [disease name]] may have a positive history of:
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| *[History finding 1]
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| *[History finding 2]
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| *[History finding 3]
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|
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| ===Common Symptoms===
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| Common symptoms of [disease] include:
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| *[Symptom 1]
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| *[Symptom 2]
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| *[Symptom 3]
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|
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| ===Less Common Symptoms===
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| Less common symptoms of [disease name] include
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| *[Symptom 1]
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| *[Symptom 2]
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| *[Symptom 3]
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |