NEUROSYPHILIS

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Definition

Neurosyphilis is an infection of the brain or spinal cord. It occurs in persons with untreated syphilis many years after they are first infected.

Causes, incidence, and risk factors

Neurosyphilis is caused by Treponema pallidum, the bacteria that cause syphillis. It occurs about 10 - 20 years after a person is first infected with syphilis. Not everyone who has syphilis will develop this complication.

There are four different forms of neurosyphilis:

• Asymptomatic
• General paresis
• Meningovascular
• Tabes dorsalis

Asymptomatic neurosyphilis occurs before symptomatic syphilis.

Symptoms

• Abnormal walk (gait)
• Blindness
• Confusion
• Dementia
• Depression
• Headache
• Incontinence
• Inability to walk
• Irritability
• Loss of muscle function
• Mental decline
• Paralysis
• Poor concentration
• Seizures
• Stiff neck
• Tremors
• Visual disturbances
• Weakness, numbness of lower extremities

Note: There may be no symptoms

Signs and tests

Signs include:

• Abnormal reflexes
• Muscle atrophy
• Muscle contractions

Blood tests can be done to detect substances produced by the bacteria that cause syphilis. The oldest test is the VDRL test.

Other tests include:

• Fluorescent treponemal antibody absorption (FTA-ABS)
• Rapid plasma reagin (RPR)
• Treponema pallidum particle agglutination assay (TPPA)

In neurosyphilis, it is important to test the spinal fluid for signs of syphilis.

Tests to look for problems with the nervous system may include:

• Cerebral angiogram
• Head CT scan
• Lumbar puncture ("spinal tap") and a cerebrospinal fluid analysis ( CSF fluid analysis)
• MRI scan of the brain, brainstem, or spinal cord

Treatment

Penicillin is used to treat neurosyphilis. The medicine may be given in various ways.

• It may be injected into a vein every day for 10 - 14 days.
• You may take probenecid by mouth 4 times a day, combined with daily muscle injections -- both for 10 - 14 days.

You must have follow-up blood tests and lumbar punctures for CSF fluid analysis at 3, 6, 12, and 24 months to make sure the infection is gone.

For information on treating syphilis, see the following articles:

• Primary syphilis
• Secondary syphilis
• Syphilis
• Tertiary syphilis

Reviewer Info: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 09/28/2008