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Neurosyphilis in the modern era
1Neurology Unit, University of Stellenbosch, South Africa.
Journal of Neurology, Neurosurgery, and Psychiatry
|November 19, 2004
Summary
Neurosyphilis diagnosis is confirmed by a positive cerebrospinal fluid (CSF) VDRL test alongside a neuropsychiatric syndrome. Alternative diagnostic markers exist if VDRL is negative, aiding in identifying this treatable infection.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Neurosyphilis, a late complication of syphilis infection, can manifest with diverse neurological and psychiatric symptoms.
- Accurate and timely diagnosis is crucial for effective treatment and preventing long-term neurological sequelae.
- Understanding the current presentation and diagnostic utility of tests is important for clinical practice.
Purpose of the Study:
- To review the clinical presentation of neurosyphilis.
- To evaluate the diagnostic value of various tests for neurosyphilis.
- To assess the current classification of neurosyphilis.
Main Methods:
- Retrospective review of patient records over 10 years.
- Inclusion criteria: positive FTA-abs test in cerebrospinal fluid (CSF).
- Assessment of clinical, radiological, and laboratory features within predefined diagnostic categories.
Main Results:
- 161 patients met neurosyphilis criteria.
- Common presentations included neuropsychiatric conditions (82 patients), stroke (24), spinal cord disease (15), and seizures (14).
- Cerebrospinal fluid (CSF) VDRL was positive in 73% of cases; 77% of followed patients had residual deficits.
Conclusions:
- Neurosyphilis diagnosis is reliable with a positive CSF VDRL and a compatible neuropsychiatric syndrome.
- A positive FTA-abs test, elevated CSF cell count, protein, or IgG index can aid diagnosis when VDRL is negative.
- Tabes dorsalis is now uncommon, but other manifestations remain consistent despite the antibiotic era.