Status epilepticus with focal neurologic deficits: a rare presentation of Neurosyphilis

Neurosyphilis is a late complication of primary syphilis and occurs with a multitude of vague symptoms. In this study, we report a patient with neurosyphilis who presented with status epilepticus, hemiplegia, and aphasia, which may be easily misdiagnosed. After performing the reactive serum test, including the toluidine red unheated serum test and the Treponema pallidum particle agglutination assay test, and cerebrospinal fluid analysis, as well as the brain Magnetic Resonance Imaging (MRI) results, we consider it general paresis of the insane, also known as dementia paralytica. The patient was started on a 14-day course with high-dose intravenous penicillin. After this treatment, the patient made significant recovery with improved cognitive function, evidenced by his Mini-mental State Examination score of 21. However, before this treatment, he could not cooperate with this exam. General paresis of the insane typically has a progressive course and normally presents 10 to 30 years after the initial infection. The manifestations of this patient and his suspicious history of transient ischemic attacks may mislead to the diagnosis of Todd's paresis or stroke. The prevalence of syphilis has been rising again in recent years. To date, there is no gold standard for the diagnosis of neurosyphilis. Early diagnosis is of great importance, as penicillin therapy is highly effective.