Neurosyphilis
Encyclopedia
Neurosyphilis is an infection of the brain or spinal cord caused by the bacterium Treponema pallidum
. It usually occurs in people who have had untreated syphilis
for many years, usually about 10 - 20 years after first infection.
Upon further diagnostic workup, the following signs may be present:
s can be done:
Also, it is important to test the cerebrospinal fluid
for signs of syphilis.
Additional tests to look for problems with the nervous system may include:
is used to treat neurosyphilis. Two examples of penicillin therapies include:
Follow-up blood tests are generally performed at 3, 6, 12, 24, and 36 months to make sure the infection is gone. Lumbar punctures for CSF fluid analysis are generally performed every 6 months.
Treponema pallidum
Treponema pallidum is a species of spirochaete bacterium with subspecies that cause treponemal diseases such as syphilis, bejel, pinta and yaws. The treponemes have a cytoplasmic and outer membrane...
. It usually occurs in people who have had untreated syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
for many years, usually about 10 - 20 years after first infection.
Symptoms and signs
Symptoms of neurosyphilis include:- Abnormal gait
- Blindness
- Confusion
- Dementia
- Depression
- Headache
- Incontinence
- Irritability
- Numbness in the toes, feet, or legs
- Poor concentration
- Seizures
- Neck stiffness
- Tremors
- Retardation
- Visual disturbances. There may be the sign of Argyll Robertson pupilArgyll Robertson pupilArgyll Robertson pupils are bilateral small pupils that constrict when the patient focuses on a near object , but do not constrict when exposed to bright light . They are a highly specific sign of neurosyphilis. In general, pupils that “accommodate but do not react” are said to show light-near...
s, which are bilateral small pupils that constrict when the patient focuses on a near object, but do not constrict when exposed to bright light. - Muscle weakness
Upon further diagnostic workup, the following signs may be present:
- Abnormal reflexes
- Muscle atrophy
- Muscle contractions
Diagnosis
In addition to evaluation of any symptoms and signs, various blood testBlood test
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s can be done:
- Venereal Disease Research Laboratory testVenereal Disease Research Laboratory testThe Venereal Disease Research Laboratory test or VDRL is a blood test for syphilis and was developed by the former Venereal Disease Research Laboratory, now the Treponemal Pathogenesis and Immunology Branch, of the United States Public Health Service...
(VDRL) - Fluorescent treponemal antibody absorption (FTA-ABS)
- Rapid plasma reaginRapid Plasma ReaginRapid Plasma Reagin refers to a type of test that looks for non-specific antibodies in the blood of the patient that may indicate that the organism that causes syphilis is present...
(RPR) - Treponema pallidum particle agglutination assayTreponema pallidum particle agglutination assayThe Syphilis TPHA test is an indirect hemagglutination assay used for the detection and titration of antibodies against the causative agent of syphilis,Treponema pallidum subspecies pallidum....
(TPPA)
Also, it is important to test the cerebrospinal fluid
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
for signs of syphilis.
Additional tests to look for problems with the nervous system may include:
- Cerebral angiogram
- Head CT scan
- Lumbar punctureLumbar punctureA lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid for biochemical, microbiological, and cytological analysis, or very rarely as a treatment to relieve increased intracranial pressure.-Indications:The...
("spinal tap") to acquire a sample for cerebrospinal fluid analysis - MRI scan of the brain, brainstem, or spinal cord
Treatment
PenicillinPenicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
is used to treat neurosyphilis. Two examples of penicillin therapies include:
- Injection into a vein several times a day for 10 - 14 days.
- One daily intramuscular injectionIntramuscular injectionIntramuscular injection is the injection of a substance directly into a muscle. In medicine, it is one of several alternative methods for the administration of medications . It is used for particular forms of medication that are administered in small amounts...
and oralOral administrationOral administration is a route of administration where a substance is taken through the mouth.-Terminology:Per os is an adverbial phrase meaning literally from Latin "by mouth" or "by way of the mouth." The expression is used in medicine to describe a treatment that is taken orally. The...
probenecidProbenecidProbenecid is a uricosuric drug that increases uric acid excretion in the urine. It is primarily used in treating gout and hyperuricemia.Probenecid was developed as an alternative to caronamide...
4 times a day, both for 10 - 14 days.
Follow-up blood tests are generally performed at 3, 6, 12, 24, and 36 months to make sure the infection is gone. Lumbar punctures for CSF fluid analysis are generally performed every 6 months.