[Neurosyphilis, the great imitator: a diagnostic challenge]

Item does not contain fulltextBACKGROUND: Neurosyphilis is a tertiary form of syphilis and is caused by the spirochete Treponema pallidum. Today, more than one type of neurosyphilis often manifest simultaneously, which can pose difficulties to the diagnostic process. CASE DESCRIPTION: A 45-year-old man presented with an attack of stammering and loss of strength in the right half of his body. Diagnostic testing led to a suspected TIA and the man was treated as such. It was only a few months later, when he had developed more neurological symptoms, that the diagnosis of 'neurosyphilis' was made. Despite treatment with benzyl penicillin, he also developed symptoms of a psychiatric nature. CONCLUSION: The patient described in this article had symptoms consistent with both meningovascular syphilis and generalised paresis. Detailed history-taking was necessary to make the diagnosis (the patient had a history of gonorrhoea). A seemingly insignificant detail - an elevated estimated sedimentation rate - was an important clue

Changes in neurosyphilis presentation: a survey on 286 patients

Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5\ua0years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS