Neurosyphilis history and symptoms: Difference between revisions

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**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<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>


* [[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">{{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>
** Persistent headache
** Persistent headache
** [[Dizziness]]
** [[Dizziness]]
** [[Vertigo]]
** [[Vertigo]]
** [[nausea]] and vomiting
** [[photophobia]]
* 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<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>
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**[[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.]]<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>
===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>
===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>
**[[headache]]
**[[nausea]] and vomiting
**[[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.
===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>
Line 78: Line 45:
*[[clinical depression|Depression]]
*[[clinical depression|Depression]]
*[[Mania]]
*[[Mania]]
*[[cranial nerve]] abnormalities especially the [[optic nerve]], [[facial nerve]], and the [[vestibulocochlear nerve]].


==References==
==References==

Revision as of 18:58, 9 March 2018


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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

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, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities) warrant further investigation and treatment for neurosyphilis.

History and Symptoms

History

Patients with tabes dorsalis may have a positive history of:

The symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis, and 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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