"Neurosyphilis results from infection of the central nervous system by the spirochete Treponema pallidum, subspecies pallidum. The disease has a heterogeneous spectrum of early and late manifestations."
"No single test confirms or rules out neurosyphilis in all stages. CSF-VDRL is often considered the gold standard, given the high specificity, although it lacks sensitivity. CSF FTA-ABS is sensitive but less specific. Treponemal tests, detecting lifelong antibodies against Treponema pallidum, are recommended for screening 21."
"It is thought that Treponema pallidum, subspecies pallidum, spreads to the central nervous system through invasion of the cerebrospinal fluid (CSF) 1,4 and triggers an immune response involving endothelial cells, lymphocytes and microglia 21. Thus, initial early manifestations of neurosyphilis include asymptomatic CSF infection before progressing to acute syphilitic meningitis that may have accompanying ocular disease (ocular syphilis) or inner ear disease (otosyphilis) 1,4. The disease then infiltrates the blood vessels of the subarachnoid space leading to arteritis in meningovascular syphilis 1,4. The most common syphilitic arteritis is Heubner arteritis of large and medium size arteries 21. Finally, in late stages of the disease after many years or even decades, the brain parenchyma and spinal cord white matter tracts are then involved leading to general paresis and tabes dorsalis 1,4. The pathogenesis of acute encephalitis seen alongside meningovascular syphilis in HIV/AIDS patients remains unclear 10,14."
"This disease is a rare entity in the antibiotic era, but when present, tends to be seen in association with HIV or AIDS, affecting approximately 1.5% of that population demographic 1. Of all patients who are diagnosed with syphilis and are left untreated, between 5-10% of patients will have evidence of symptomatic neurosyphilis 1,18."
"No single test confirms or rules out neurosyphilis in all stages. CSF-VDRL is often considered the gold standard, given the high specificity, although it lacks sensitivity. CSF FTA-ABS is sensitive but less specific. Treponemal tests, detecting lifelong antibodies against Treponema pallidum, are recommended for screening 21."
"Lumbar puncture indications include neurological or ocular symptoms, uncontrolled HIV, low CD4 count, high VRDL/RPR titre, syphilis treatment failure, and antiretroviral therapy-naive status 21."
"reactive CSF-VDRL or CSF FTA-ABS tests"
Expected headings
"Early neurosyphilis"
"Late neurosyphilis"
"CSF"
"Early neurosyphilis"
"Late neurosyphilis"
"The clinical presentation is very varied and largely depends on the temporal stage of the disease and the corresponding area of the central nervous system that has been affected. In addition to features of neurosyphilis, signs and symptoms of secondary and other forms of tertiary syphilis may also be present 1-6."
"clinical features identical to those of a bacterial leptomeningitis, such as headache, neck stiffness, seizures, cranial neuropathies (especially CN III, VI, VII and VIII), and raised intracranial pressure or hydrocephalus 1,4,18"
"It is thought that Treponema pallidum, subspecies pallidum, spreads to the central nervous system through invasion of the cerebrospinal fluid (CSF) 1,4 and triggers an immune response involving endothelial cells, lymphocytes and microglia 21. Thus, initial early manifestations of neurosyphilis include asymptomatic CSF infection before progressing to acute syphilitic meningitis that may have accompanying ocular disease (ocular syphilis) or inner ear disease (otosyphilis) 1,4. The disease then infiltrates the blood vessels of the subarachnoid space leading to arteritis in meningovascular syphilis 1,4. The most common syphilitic arteritis is Heubner arteritis of large and medium size arteries 21. Finally, in late stages of the disease after many years or even decades, the brain parenchyma and spinal cord white matter tracts are then involved leading to general paresis and tabes dorsalis 1,4. The pathogenesis of acute encephalitis seen alongside meningovascular syphilis in HIV/AIDS patients remains unclear 10,14."
"if cranial neuropathies are present then cranial nerve enhancement may be appreciated, most commonly of CN III, VI, VII and VIII 1,2,14,18"
"imaging of joints (plain radiograph, CT or MRI) may reveal features in keeping with the rare complication of Charcot joints 19"
"clinical features identical to those of a bacterial leptomeningitis, such as headache, neck stiffness, seizures, cranial neuropathies (especially CN III, VI, VII and VIII), and raised intracranial pressure or hydrocephalus 1,4,18"
"if cranial neuropathies are present then cranial nerve enhancement may be appreciated, most commonly of CN III, VI, VII and VIII 1,2,14,18"
"if acute encephalitis is present, the radiographical features of mesiotemporal T2-weighted hyperintensities seen are indistinguishable from herpes simplex encephalitis 10,14; there may also be residual atrophic cerebral changes seen once the acute phase has resolved 8"