Jacobs Journal of Psychiatry and Behavioural Science

Neurosyphilis – Still a Diagnostic and Therapeutic Challenge

Published on: 2016-09-16

Abstract

Neurosyphilis results from an infection of the brain, meninges and/or the spinal cord and may develop in persons in whom a manifest syphilis has passed untreated. The clinical manifestations are often diverse and may present as a psychiatric disorder. This article reports two cases with neurosyphilis who were followed for 33 and 21 years respectively. In one of these cases neuropathological findings are presented. Retrospective evaluations of all medical records were performed to characterize psychiatric and other clinical features, laboratory and brain imaging findings. Both patients presented a variety of psychiatric manifestations and were initially misdiagnosed. The diagnosis was based on positive serology, cerebrospinal fluid, and neuropsychiatric symptoms and supported by brain imaging. There was a marked improvement in both patients after penicillin therapy. In the case with autopsy mixed brain pathology with atrophy of the frontotemporal areas and advanced vascular pathology was seen. These cases emphasize the importance of screening for syphilis, especially in patients with unexplained psychiatric and neurological symptoms and signs.

Keywords

Neurosyphilis; Psychiatric Symptoms; Frontotemporal Syndrome; Language Disturbances; Cerebrovascular Pathology