Neurosyphilis
CNS infection by syphilis bacterium, treatable with penicillin.
Neurosyphilis is a central nervous system infection caused by *Treponema pallidum*, the same bacterium responsible for the sexually transmitted infection syphilis. Since the introduction of modern antibiotics, most cases of neurosyphilis have occurred in people also infected with HIV. The condition can appear at any point after the initial syphilis infection, and its symptoms vary widely depending on which part of the central nervous system is affected.
**Signs and symptoms** While syphilis is generally divided into primary, secondary, latent, and tertiary stages, neurosyphilis is usually described as early, intermediate, or late. It can develop at any time after the initial infection.
**Early and intermediate neurosyphilis** Early neurosyphilis often shows no clinical symptoms. When symptoms do appear, meningitis is the most common neurological presentation, typically arising within a year of the initial infection. The symptoms of syphilitic meningitis resemble those of other forms of meningitis: headache, stiff neck, sensitivity to light, confusion, nausea, and vomiting. Inflammation of the meninges can also affect cranial nerves, most often the facial nerve, leading to facial paralysis. Cerebral gummas—granulomatous destruction of brain tissue caused by syphilis—can also trigger meningitis-like symptoms. Meningovascular syphilis is considered an intermediate stage, usually appearing 5 to 12 years after infection. It results from inflammation of the blood vessels that supply the central nervous system, causing brain tissue death (ischemia). This can present as a stroke or spinal cord injury. The specific signs depend on which blood vessel is affected; the middle cerebral artery is most commonly involved, leading to symptoms such as weakness, sensory loss, eye deviation, and hemineglect syndrome.
**Late neurosyphilis** Parenchymal syphilis occurs in the late stage, typically 15 to 25 years after the initial infection. It usually takes the form of either tabes dorsalis or general paresis. Tabes dorsalis, also called locomotor ataxia, involves degeneration of the posterior columns of the spinal cord. Symptoms include pain, a wide-based ataxic gait, paresthesias, bowel or bladder incontinence, loss of position and vibratory sense, acute episodic gastrointestinal pain, Charcot joints, and reduced reflexes.
Quick Facts
- Specialty
- Neurology, infectious diseases
- Symptoms
- Headache, stiff neck, paresthesia, loss of bladder control, personality and mood changes
- Causes
- Treponema pallidum
- Risks
- HIV infection, unprotected sex
- Treatment
- Antibiotics (penicillin G or ceftriaxone)
Facts from the source article.
Lore & Background
Neurosyphilis may occur any time after initial infection with Treponema pallidum. Early neurosyphilis often has no clinical symptoms, but meningitis is the most common neurological presentation, typically arising within one year of infection. Meningovascular syphilis, an intermediate stage, presents 5 to 12 years after infection due to inflammation of blood vessels supplying the central nervous system, potentially causing stroke or spinal cord injury. Late neurosyphilis, presenting 15 to 25 years after infection, includes tabes dorsalis, a degenerative process of the posterior spinal cord, and general paresis, a slow degenerative process of the brain leading to neuropsychiatric symptoms.
Reader's Guide
Neurosyphilis remains a significant condition because it can affect any part of the central nervous system at any stage of syphilis infection. In the era of modern antibiotics, the majority of cases have been reported in HIV-infected patients. Diagnosis relies on clinical history, physical neurological examination, and cerebrospinal fluid analysis, with a positive CSF-VDRL test in the presence of neurological symptoms sufficient for diagnosis. Standard treatment is intravenous penicillin G for 10 to 14 days. The pathogenesis is not fully known, partly because the organism is not easily cultured. Ocular syphilis and otosyphilis may occur at any point after infection, affecting the eye or vestibulocochlear nerve respectively. Risk factors overlap with those for syphilis and other STIs, including high-risk sexual behavior and HIV co-infection.
Did You Know?
- Neurosyphilis may occur at any stage of syphilis infection.
- The most common early neurological presentation is meningitis, typically within one year of infection.
- Tabes dorsalis, a late form, involves degenerative loss of myelin in the posterior columns of the spinal cord.
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