Neurosyphilis

Abnormalities in the cerebral spinal fluid have been noted in approximately 13% of patients that don’t have treated primary syphilis and in 25-40% of patients with uncared for secondary syphilis. Syphilis or T. pallidum has been recognized by animal inoculation or polymerase chain reaction in the cerebral spinal fluid of 15-40% of patients with untreated primary and secondary syphilis, even without other abnormalities.

First, initially in the central nervous system there is an invasion of spirochetes, ocurring during early syphilis and if left untreated could resolve by itself or spontaneously; however, it could continue on as asymptomatic syphilitic meningitis, or advance to symptomatic acute syphilitic meningitis. Progression occurs from the early asymptomatic or symptomatic meningeal infection to either meninogovascular syphilis as early as 5-12 years after a primary infection or could hold off until the later years (18-25 years later) to a form of neurosyphilis known as tabes or paresis. The continuum of change that occurs is progressive in nature and not of discrete steps. Puzzling, is the selective nature of syphilis to become neurosyphilis in some untreated people and not in others. Merritt and colleagues have developed a classification scheme for CNS syphilis. Such scheme is from the “pre-antibiotic” era.

 

Classification of Neurosyphilis

Percent of 100

Asymptomatic

31

Early

Late

Meningeal

20

Acute syphilitic meningitis

6

Meningovascular

11

Cerebral

Spinal form

3

Parenchymatous

48

General paresis

12

Tabes dorsalis

30

Taboparesis (mixed)

3

Optic atrophy

3

Gummatous

Cerebral form

Spinal form

 

*Data from Merritt HH, et al. Neurosyphilis. New York: Oxford, 1946

 

For further reading on specific Neurosyphilitic conditions.

 

Early neurosyphilis:

1. Asymptomatic

2. Acute syphilitic meningitis

3. Meningovascular syphilis

4. Meningovascular syphilis of the spinal cord

5. General paresis

6. Tabes dorsalis

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