Neurosyphilis Presenting as Intermittent Explosive Disorder and Acute Psychosis

Abstract

We present a case of a patient with tertiary syphilis, manifesting as acute psychosis, auditory hallucinations and intermittent explosive disorder with pending legal ramifications for physical violence. Our patient had been seen and treated by a psychologist with Aripiprazole for his erratic and aggressive behavior coupled with his new found psychosis over a one-year period with no avail. Prior accounts of interaction with the patient described him as "easy going", "laid back", and cooperative. Our patient had a complete return to baseline mentation and functionality post treatment with 4 Million Units every four hours of penicillin for two weeks. Neurosyphilis is a disease that greatly affects the mental functioning capacity of those infected. While treatment of syphilis has become greatly straightforward, those living in impoverished conditions and without a continual access to the health care system can progress through the stages of syphilis. It is of vital importance to keep syphilis on our differential for patients with rapidly progressing and broadly encompassing psychiatric disturbances especially in patients that have a lower socioeconomic status.

Yttrium-90 microsphere radioembolisation for unresectable hepatocellular carcinoma

“…Knowledge of technical aspects of embolisation, hepatic artery anatomy, and flow characteristics is essential for safe and e ective delivery of this new intervention. Published data from multiple independent sources support enhancement of survival in a distinct subset of people with hypervascular tumours and intact liver function (Rhee 2005;Kulik 2006;Saini 2019). Unlike what is considered a contraindication for other embolointerventions, portal vein thrombosis is not considered to be a major contraindication for Y-90 radioembolisation.…”

“…This intervention seems an e ective instrument for downstaging the tumour to resection or providing a bridge to liver transplantation. Compared to historical controls, the post-embolisation syndrome following Y-90 microsphere radioembolotherapy is milder than following chemoembolisation (Murthy 2011;Saini 2019).…”

An Association of Pathogens and Biofilms with Alzheimer’s Disease

“…It is encephalomyelitis that can lead to symptoms similar to those seen in AD patients, including visual disturbances, speech impairments, and dementia [28]. B. burgdorferi DNA is detectable in AD brains, and Aβ plaque aggregation is observed in brain tissues infected with the bacterium [27,29]. Additionally, hyperphosphorylation of tau can be seen in infected microglia, suggesting that B. burgdorferi could be a potential cause of AD and its pathology [30].…”

“…Again, if no treatment is given, the disease will progress to tertiary syphilis, wherein many organs can be damaged. Among them, the brain may be affected in neurosyphilis, when syphilis affects the brain and spinal cord [29]. While there are several neurosyphilis types, general paresis clinically presents with symptoms similar to AD, such as dementia, personality changes, and general cognitive impairments [29].…”

“…Among them, the brain may be affected in neurosyphilis, when syphilis affects the brain and spinal cord [29]. While there are several neurosyphilis types, general paresis clinically presents with symptoms similar to AD, such as dementia, personality changes, and general cognitive impairments [29]. Earlier evidences of T. pallidum in the brain showed that the bacterium could form neurofibrillary tangles, and Aβ aggregates closely resemble those seen in AD brains [31].…”