Incidence and Clinical Presentation of Neurosyphilis: A Retrospective Study of 81 Cases

Abstract

Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1965-2005). The investigation was based on the retrospective review of patients with neurosyphilis hospitalized in our hospital from 1965 to 2005 (period A: 1965-1984 and B: 1985-2005). Eighty one patients with neurosyphilis were studied. Typical forms represent 68.6% of cases of neurosyphilis in period A. In period B, 85.7% of the cases are presented with atypical clinical patterns. Typical forms of the disease were no longer common, while atypical and masked clinical patterns prevailed. Neuropsychiatric symptoms were the most common manifestations of the disease.

Neurocognitive and psychiatric changes as the initial presentation of neurosyphilis

“…Features of the classic presentations were much less frequent in the latter period than in the earlier period, a difference attributed to the widespread use of antibiotics and better screening practices. 5 In all 3 cases we have described, the patients did not have pupillary abnormalities, and findings on cardiovascular and dermatologic examinations were unremarkable. Table 1 describes the signs and symptoms of neurosyphilis and their frequencies.…”

“…In the retrospective review by Mitsonis and colleagues, mental disorders occurred in 86% and cognitive impairment in 64% of patients presenting between 1985 and 2005. 5 Our first case also highlights various other features in neurosyphilis, such as apparent mineral deposition in the basal ganglia observed on Practice MRI scans. We found only one other reported case of a patient with neurosyphilis who had mineral deposition, presumed to be ferritin, in the basal ganglia.…”

“…3 In a retrospective study, Mitsonis and colleagues examined the clinical features of 81 patients presenting with neurosyphilis between 1965-84 and 1985-2005. 5 They examined the prevalence of typical features, such as tabes dorsalis, progressive general paresis and meningovascular syphilis. Features of the classic presentations were much less frequent in the latter period than in the earlier period, a difference attributed to the widespread use of antibiotics and better screening practices.…”

Psychiatric Manifestations of Neurosyphilis

“…Headache, dizziness, or hearing loss was observed in 10% of the patients, 7% of the patients had cerebral seizures. Mitsonis et al (2008) Table 2. Publications with psychiatric differential diagnosis of neurosyphilis according to ICD-10 compared to the classification of Hoche (1912);…”

Meningovascular neurosyphilis with basilar artery thrombosis, a case report and literature review

“…En 1999, según la Organización Mundial de la Salud (OMS), la incidencia mundial era de 12 millones de casos, 3 de ellos en Latinoamérica y África (1,2). No obstante, dado el advenimiento de técnicas de diagnóstico confiables y el tratamiento efectivo con penicilinas, sus manifestaciones terciarias neurológicas han cambiado; la parálisis general progresiva y la tabes dorsal son poco frecuentes hoy en día (3,4) y, por el contrario, las manifestaciones neurosiquiátricas se vienen presentando más a menudo (5).…”