Neurological Disorders: Neurosyphilis

Neurosyphilis is the syphilis infection of the nervous system, and this condition especially involves the central nervous system (brain and spinal cord).

Syphilis is caused by a bacteria belonging to the group of spirochetes and is called as Treponema palludum. This disease is grouped under STD (sexually transmitted diseases). There are three stages of the disease and not all patients will reach the later stages.

The nervous system is typically involved only during the later stage (stage 3) of the disease, although it seems that the bacteria enters these structure early in the disease. The bacteria initiate an inflammatory reaction in the affected organs like brain, spinal cord etc that also includes typical granulomatous lesions called as gummas.

There are several characteristic syndromes associated with syphilitic infection of the nervous system including;

• Meningovascular syphilis
• Syphilitic meningitis
• Tabes dorsalis (spinal cord involvement)
• GPI (general paralysis of insane) etc

So the clinical manifestations could be protean. Some of the important manifestations include;

• Related with meningovascular syphilis - Strokes (due to syphilitic vascultis of the brain)

• Chronic Syphilitic meningitis related manifestations (headache, cranial neuropathies, communicating hydrocephalus etc)

• Tabes dorsalis related – ataxia or in-coordination of the limbs, especially of the legs, increased ataxia when dark or dim around, decreased bladder sensation & overflow incontinence etc

• GPI – dementia and/or psychotic manifestations, delusions of grandeur etc

High index of suspicion is necessary as there are many neurological diseases that mimic syphilis of the nervous system.

The following investigations are required at the minimum;

• MRI of the brain (or at least a CT)
• Blood tests for RPR (or VDRL), Specific blood test for syphilis
• Spinal fluid analysis including cell count, protein, VDRL etc (CSF)

MRI of the spinal cord, EMG test, Evoked potential studies may be required on case to case basis.

Benzyl Penicillin is the drug of choice for syphilis at any stage and for the later stages there is an obligatory requirement of penicillin. Accordingly for syphilis of the nervous system benzyl penicillin is almost a mandatory requirement. If patient is penicillin sensitive then they are desensitized and penicillin is given.

Symptomatic treatment is also given depending upon what are patient’s complaints.

A neurologist is frequently involved in the care of patients with Neurosyphilis.