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Did you rule out neurosyphilis?

Ricardo Nitrini¹, Anderson Rodrigues Brandão de Paiva¹, Leonel Tadao Takada¹

¹MD, PhD, Behavioral and Cognitive Neurology Unit, Department of Neurology, and Cognitive Disorders Reference Center (CEREDIC), Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo SP, Brazil.

Dementia & Neuropsychologia

|December 8, 2017

Summary

Neurosyphilis, a cause of dementia, remains a diagnostic challenge, especially in regions with high syphilis prevalence. Early diagnosis via blood tests is crucial for managing these rare but serious neuropsychiatric conditions.

Keywords:

dementia neuropsychiatry neurosyphilis paretic neurosyphilis syphilis

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Area of Science:

Neurology
Infectious Diseases
Public Health

Background:

Neurosyphilis, a complication of syphilis, can lead to dementia and neuropsychiatric syndromes.
While rare in developed nations, syphilis and neurosyphilis persist in developing countries due to potential gaps in early diagnosis and treatment.
Syphilitic dementia presents diagnostic challenges, particularly in its early stages.

Purpose of the Study:

To report cases of syphilitic dementia encountered in a Brazilian cognitive and behavioral neurology unit.
To highlight the initial symptoms and diagnostic difficulties associated with neurosyphilis.
To emphasize the importance of timely diagnosis and treatment of neurosyphilis.

Main Methods:

Retrospective review of neurosyphilis cases from January 1991 to November 2009.
Inclusion of patients undergoing blood treponemal tests, with lumbar puncture for positive results.
Analysis of patient demographics, symptoms, and diagnostic timelines.

Main Results:

Nine cases of neurosyphilis were identified (0.77% of total cases).
All affected patients were male, with a mean age of 47.8 years.
Patients presented with diverse neuropsychiatric symptoms, leading to delayed diagnoses (median 24 months).
Full recovery was achieved in only one patient post-treatment.

Conclusions:

Neurosyphilis, though infrequent, causes varied neuropsychiatric syndromes and remains a concern.
A simple blood treponemal test can effectively screen for neurosyphilis.
Universal screening with blood treponemal tests is recommended for patients with neuropsychiatric symptoms, especially in endemic areas.