Neurosyphilis physical examination: Difference between revisions

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{{Neurosyphilis}}
{{Neurosyphilis}}
{{CMG}}; {{AE}}{{MMJ}}
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==Overview==
==Overview==
Patients with tabes dorsalis may be asymptomatic. Physical examination of patients with tabes dorsalis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]], impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]].
Patients with neurosyphilis may be asymptomatic. Physical examination of patients with neurosyphilis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]], impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]].


==Physical Examination==
==Physical Examination==
*Physical examination of patients with tabes dorsalis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]] (bilateral small pupils that constrict when the patient focuses on a near object, but do ''not'' constrict when exposed to bright light), Impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]] (a test used for examination of neurological function for balance).
*Many manifestations of neurosyphilis usually develops 15-20 years after primary infection.
 
*Physical examination of patients with neurosyphilis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]] (bilateral small pupils that constrict when the patient focuses on a near object, but do ''not'' constrict when exposed to bright light), Impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]] (a test used for examination of neurological function for balance).
===Appearance of the Patient===
*Patients with tabes dorsalis may be asymptomatic.<ref name="pmid26558247">{{cite journal| author=Crozatti LL, de Brito MH, Lopes BN, de Campos FP| title=Atypical behavioral and psychiatric symptoms: Neurosyphilis should always be considered. | journal=Autops Case Rep | year= 2015 | volume= 5 | issue= 3 | pages= 43-7 | pmid=26558247 | doi=10.4322/acr.2015.021 | pmc=4636106 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26558247  }} </ref>


===Vital Signs===
===Vital Signs===


*Usually [[vital signs]] are normal.<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Usually [[vital signs]] of patients with neurosyphilis are normal.<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
===Skin===
===Skin===
Important cutanous findings in tabes dorsalis include:
Important cutanous findings in neurosyphilis include:
* [[granulomatous]] [[Skin lesion|skin lesions]]:  
* Granulomatous [[Skin lesion|skin lesions]]:  
** One of the late manifestations of [[tertiary syphilis]] called [[gumma]] may be present
** One of the late manifestations of [[tertiary syphilis]] called [[gumma]] may be present
** [[Gumma]]<nowiki/>s are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].<ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref>
** [[Gumma]]<nowiki/>s are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].<ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref>
Line 30: Line 26:


===HEENT===
===HEENT===
Abnormalities of the [[head]] include:<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref><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>
Abnormalities of the [[head]] in patients with neurosyphilis include:<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref><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><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><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><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>
* Icteric sclera may be present
* Icteric sclera
*[[Argyll Robertson pupil|Argyll Robertson pupils]] may be present
*[[Argyll Robertson pupil|Argyll Robertson pupils]]  
* Hearing acuity may be reduced
*[[Cranial nerves|Cranial nerve]] dysfunction symptoms:
** [[Diplopia]]
**[[Impaired vision]]
**[[Hearing loss]]
**Voice changes
===Neck===
* [[Neck stiffness]]
* [[Brudzinski's sign]]
* [[Kernig's sign]]


===Neck===
*Cervical [[lymphadenopathy]]
*Cervical [[lymphadenopathy]]  
**Nontender
**Mobile
**Small


===Lungs===
===Lungs===
* [[Granulomatosis]] manifestations in lungs<nowiki/><ref name="pmid14931376">{{cite journal| author=MORGAN AD, LLOYD WE, PRICE-THOMAS C| title=Tertiary syphilis of the lung and its diagnosis. | journal=Thorax | year= 1952 | volume= 7 | issue= 2 | pages= 125-33 | pmid=14931376 | doi= | pmc=1019150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14931376  }} </ref>
* <nowiki/>Bilaterally coarse [[crackles]]<ref name="pmid14931376">{{cite journal| author=MORGAN AD, LLOYD WE, PRICE-THOMAS C| title=Tertiary syphilis of the lung and its diagnosis. | journal=Thorax | year= 1952 | volume= 7 | issue= 2 | pages= 125-33 | pmid=14931376 | doi= | pmc=1019150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14931376  }} </ref><nowiki/>
*Bilaterally coarse [[crackles]]


===Neuromuscular===
===Neuromuscular===
*Positive [[Romberg's test|romberg test]] (a test used for examination of neurological function for balance) is one of the most important findings in [[physical examination]] of patients with tabes dorsalis<ref name="pmid17235095">{{cite journal| author=French P| title=Syphilis. | journal=BMJ | year= 2007 | volume= 334 | issue= 7585 | pages= 143-7 | pmid=17235095 | doi=10.1136/bmj.39085.518148.BE | pmc=1779891 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17235095  }} </ref>
*Positive [[Romberg's test|romberg test]] <ref name="pmid17235095">{{cite journal| author=French P| title=Syphilis. | journal=BMJ | year= 2007 | volume= 334 | issue= 7585 | pages= 143-7 | pmid=17235095 | doi=10.1136/bmj.39085.518148.BE | pmc=1779891 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17235095  }} </ref>
*Patient is usually oriented to persons, place, and time
* [[Hyporeflexia]] or [[areflexia]]<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>
* [[Hyporeflexia]] or [[areflexia]]<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>
* Impaired balance bilateral [[Babinski's Reflex]]<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
* Bilateral [[Babinski's Reflex]]<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
* Bilateral [[muscle weakness]] mostly in [[lower limbs]]<ref name="pmid16778468">{{cite journal| author=Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R| title=Neurosyphilis manifesting as spinal transverse myelitis. | journal=Medicina (Kaunas) | year= 2006 | volume= 42 | issue= 5 | pages= 401-5 | pmid=16778468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16778468  }} </ref>
* Bilateral [[muscle weakness]] in [[lower limbs]]<ref name="pmid16778468">{{cite journal| author=Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R| title=Neurosyphilis manifesting as spinal transverse myelitis. | journal=Medicina (Kaunas) | year= 2006 | volume= 42 | issue= 5 | pages= 401-5 | pmid=16778468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16778468  }} </ref><ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref>
* [[Argyll Robertson pupil|Argyll Robertson pupils]] (bilateral small pupils that constrict when the patient focuses on a near object, but do ''not'' constrict when exposed to bright light)<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref>
*Bilateral [[sensory loss]] in lower extremities<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Bilateral [[sensory loss]] mainly in lower extremities<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Broad base gait
*[[Sensory ataxia|Sensory ataxic gait]]<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*[[Sensory ataxia|Sensory ataxic gait]]<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*[[Cranial nerve palsy]] ([[Diplopia|diplopia,]] [[mydriasis]]) caused by [[gummatous]] [[neurosyphilis]]<ref name="pmid8279327">{{cite journal| author=Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J| title=Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings. | journal=AJNR Am J Neuroradiol | year= 1993 | volume= 14 | issue= 6 | pages= 1329-31 | pmid=8279327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8279327  }} </ref>
*[[Cranial nerve palsy]] ([[Diplopia|diplopia,]] [[mydriasis]])<ref name="pmid8279327">{{cite journal| author=Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J| title=Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings. | journal=AJNR Am J Neuroradiol | year= 1993 | volume= 14 | issue= 6 | pages= 1329-31 | pmid=8279327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8279327  }} </ref>
*Finger-to-nose test is usually abnormal<ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420  }} </ref>
*Abnormal finger-to-nose test <ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420  }} </ref>
===Extremities===
===Extremities===
* [[Charcot joint|Charcot arthropathy]] ([[Charcot joint]]) of the foot<ref name="pmid23919113">{{cite journal| author=Kaynak G, Birsel O, Güven MF, Oğüt T| title=An overview of the Charcot foot pathophysiology. | journal=Diabet Foot Ankle | year= 2013 | volume= 4 | issue=  | pages=  | pmid=23919113 | doi=10.3402/dfa.v4i0.21117 | pmc=3733015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23919113  }} </ref>
* [[Charcot joint|Charcot arthropathy]]<ref name="pmid23919113">{{cite journal| author=Kaynak G, Birsel O, Güven MF, Oğüt T| title=An overview of the Charcot foot pathophysiology. | journal=Diabet Foot Ankle | year= 2013 | volume= 4 | issue=  | pages=  | pmid=23919113 | doi=10.3402/dfa.v4i0.21117 | pmc=3733015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23919113  }} </ref>


*Muscle atrophy
*Muscle atrophy

Latest revision as of 21:57, 5 April 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

Patients with neurosyphilis may be asymptomatic. Physical examination of patients with neurosyphilis is usually remarkable for: Argyll-Robertson pupils, impaired vibratory and proprioception sense, broad base and sensory ataxic gait and positive romberg's test.

Physical Examination

  • Many manifestations of neurosyphilis usually develops 15-20 years after primary infection.
  • Physical examination of patients with neurosyphilis is usually remarkable for: Argyll-Robertson pupils (bilateral small pupils that constrict when the patient focuses on a near object, but do not constrict when exposed to bright light), Impaired vibratory and proprioception sense, broad base and sensory ataxic gait and positive romberg's test (a test used for examination of neurological function for balance).

Vital Signs

Skin

Important cutanous findings in neurosyphilis include:


Tertiary syphilis gumma
Source:By NearEMPTiness (Wie Schönes Wissen schafft im MUT) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons, rID: 51340


HEENT

Abnormalities of the head in patients with neurosyphilis include:[3][4][5][6][7]

Neck

Lungs

Neuromuscular

Extremities

  • Muscle atrophy

References

  1. ↑ 1.0 1.1 1.2 Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 160–3. PMC 2582679. PMID 19148316.
  2. ↑ Carlson JA, Dabiri G, Cribier B, Sell S (2011). "The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity". Am J Dermatopathol. 33 (5): 433–60. doi:10.1097/DAD.0b013e3181e8b587. PMC 3690623. PMID 21694502.
  3. ↑ 3.0 3.1 Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". J Neuroophthalmol. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
  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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ MORGAN AD, LLOYD WE, PRICE-THOMAS C (1952). "Tertiary syphilis of the lung and its diagnosis". Thorax. 7 (2): 125–33. PMC 1019150. PMID 14931376.
  9. ↑ French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
  10. ↑ 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.
  11. ↑ Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M (2009). "Case of neurosyphilis presented as recurrent stroke". Oman Med J. 24 (2): 134–6. doi:10.5001/omj.2009.29. PMC 3273935. PMID 22334859.
  12. ↑ Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R (2006). "Neurosyphilis manifesting as spinal transverse myelitis". Medicina (Kaunas). 42 (5): 401–5. PMID 16778468.
  13. ↑ Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J (1993). "Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings". AJNR Am J Neuroradiol. 14 (6): 1329–31. PMID 8279327.
  14. ↑ Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD (2009). "Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report". Cases J. 2: 8334. doi:10.4076/1757-1626-2-8334. PMC 2769430. PMID 19918420.
  15. ↑ Kaynak G, Birsel O, Güven MF, Oğüt T (2013). "An overview of the Charcot foot pathophysiology". Diabet Foot Ankle. 4. doi:10.3402/dfa.v4i0.21117. PMC 3733015. PMID 23919113.

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