Psychiatric manifestations of neurosyphilis

To investigate referral patterns, initial diagnoses and clinical features of patients with neurosyphilis who present with psychiatric manifestations, records were kept of 21 such patients admitted to an acute psychiatric ward. In none of the 12 cases referred from primary care workers was the possibility of neurosyphilis considered. In only 3 cases was this diagnosis considered on admission to the psychiatric ward before serum serological test results were known. Commonest presenting symptoms were personality change (16 patients) and memory impairment (13 patients). Neurological signs or symptoms were also common, particularly absent pupillary reaction to light (5 patients) and buccolingual masticatory movements (5 patients). A positive serological test remains the single most important factor in identifying patients with neurosyphilis.