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Bilateral oculomotor paralysis due to neurosyphilis
Annals of Neurology
|January 1, 1978
Summary
Neurosyphilis can cause isolated bilateral third nerve paresis. Treatment with penicillin resolved the condition, highlighting its effectiveness in managing this rare neurological presentation.
Area of Science:
- Neuro-ophthalmology
- Infectious Diseases
- Neurology
Background:
- Neurosyphilis, a tertiary stage of syphilis infection, can manifest with diverse neurological symptoms.
- Bilateral third nerve (oculomotor nerve) paresis is a rare presentation of neurosyphilis, typically accompanied by other neurological deficits.
Observation:
- A case of isolated bilateral third nerve paresis was observed.
- The patient presented with positive serological findings for syphilis in both blood and cerebrospinal fluid (CSF).
- Cerebrospinal fluid analysis revealed pleocytosis (increased white blood cell count) and elevated protein levels.
Findings:
- The patient's presentation of isolated bilateral third nerve paresis was attributed to neurosyphilis.
- Serological tests confirmed syphilis infection in the blood and CSF.
- CSF analysis indicated active central nervous system inflammation.
Implications:
- This case expands the known clinical spectrum of neurosyphilis.
- It underscores the importance of considering neurosyphilis in patients with isolated cranial nerve palsies, even without other neurological signs.
- Penicillin therapy proved effective in resolving both the neurological deficit and CSF abnormalities, reinforcing its role as the primary treatment for neurosyphilis.