Neurosyphilis: A Changing Diagnostic Problem?

Wolters, Erik Ch.

doi:10.1159/000116306

Cited by 20 publications

(13 citation statements)

References 6 publications

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“…In addition to our study, all series from the penicillin era yield a decreasing frequency of late forms, mainly tabes dorsalis. This fact had been pointed up in previous discussions [5, 9, 16, 18, 19, 20], supporting the view that these differences are most probably due to the expanded use of antibiotics in recent years and to the effect of HIV coinfection. Our results, however, show the same trends in clinical patterns of NS in HIV-negative patients; thus, the role of HIV must be discrete, if anything.…”

Section: Discussionsupporting

confidence: 67%

“…In table 8, the different clinical forms in several historical series are compared [5, 9, 14, 15, 16, 17]. In order to overcome differences in classification criteria, we have made some corrections, specified in the table.…”

Section: Discussionmentioning

confidence: 99%

“…During the last decades, some authors have reported changes in the clinical patterns of this disease [8, 9, 10, 11, 12], which have generally been attributed to the expanded use of antibiotics as well as to the growing number of patients coinfected with HIV.…”

Section: Introductionmentioning

confidence: 99%

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Current Clinical Spectrum of Neurosyphilis in Immunocompetent Patients

et al. 2004

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Background: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. Objective: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. Methods: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. Results: Forty-three patients met NS criteria. The yearly incidence was 0.2– 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. Conclusions: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Current Clinical Spectrum of Neurosyphilis in Immunocompetent Patients

et al. 2004

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“…22 Wolters compared pre-and post-antibiotic era patients, and apart from a decline in tabes dorsalis, no other significant differences were seen. 23 The present study indicates that the classical presentations of neurosyphilis have not altered, although tabes dorsalis has become rare. Our patients had clinical syndromes that were identical to those described in the pre-antibiotic era-that is, neuropsychiatric presentations, stroke, cranial nerve and brain stem dysfunction, seizures with or without encephalopathy, and spinal cord disease, both acute and indolent.…”

Section: How Is Neurosyphilis Diagnosed?mentioning

confidence: 47%

Neurosyphilis in the modern era

Timmermans

Carr²

2004

Journal of Neurology, Neurosurgery & Psychiatry

190

103

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Objective: To review the nature of the presentation of neurosyphilis, the value of diagnostic tests, and the classification of the disease. Methods: A retrospective review was carried out of the records of patients who had been identified as possible cases of neurosyphilis by a positive FTA-abs test in the CSF. The review extended over 10 years at a single hospital which served a population of mixed ancestry in a defined catchment area in the Western Cape province of South Africa. Patients were placed in predefined diagnostic categories, and clinical, radiological, and laboratory features were assessed. Results: 161 patients met diagnostic criteria for neurosyphilis: 82 presented with combinations of delirium and dementia and other neuropsychiatric conditions, and the remainder had typical presentations such as stroke (24), spinal cord disease (15), and seizures (14). The average age of presentation ranged from 35.9 to 42.6 years in the different categories of neurosyphilis. Of those followed up, 77% had residual deficits from their initial illness. Cerebrospinal fluid (CSF) VDRL was positive in 73% of cases. Conclusions: The diagnosis of neurosyphilis can be made with reasonable certainty if there is an appropriate neuropsychiatric syndrome associated with a positive CSF VDRL. If the VDRL is negative, a positive FTA-abs in an appropriate clinical setting, associated with raised CSF cell count, protein, or IgG index, is a useful method of identifying neurosyphilis. Tabes dorsalis has become uncommon, but this is likely to be the only manifestation of neurosyphilis that has been altered during the antibiotic era.

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“…Se denomina endarteritis de Heubner cuando hay comrpomiso de los vasos de grande y mediano tamaño, y arteritis de Nissl, cuando afecta los vasos pequeños. Cuando la íntima se engruesa en exceso, se ocluye la luz del vaso y se presenta la trombosis (8).…”

Section: Discussionunclassified