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Moursi MO, Hamam W, Hajjar A, Es‐Salim M, Aboukhalaf S, Jamil O, Zahid M. Ischemic stroke as an initial presentation of neurosyphilis in a newly diagnosed HIV patient: A case report and literature review. Clin Case Rep 2024; 12:e8794. [PMID: 38736579 PMCID: PMC11087217 DOI: 10.1002/ccr3.8794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/02/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
With syphilis resurgence, physicians should be more vigilant to infection-induced cerebral vasculitis in high-risk patients presenting with neurological symptoms. In this case, neurosyphilis should not be missed. Thorough serologic screening and lumbar puncture are crucial for diagnosis, and further research is needed for safe and effective treatments in these populations.
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Affiliation(s)
- Moaz O. Moursi
- Department of Internal MedicineHamad General HospitalDohaQatar
- College of Medicine, QU HealthQatar UniversityDohaQatar
| | - Wael Hamam
- Department of Internal MedicineHamad General HospitalDohaQatar
| | - Adnan Hajjar
- Department of Internal MedicineHamad General HospitalDohaQatar
| | | | - Soha Aboukhalaf
- Department of Internal MedicineHamad General HospitalDohaQatar
- College of Medicine, QU HealthQatar UniversityDohaQatar
| | - Omar Jamil
- College of Medicine, QU HealthQatar UniversityDohaQatar
- Department of RadiologyHamad General HospitalDohaQatar
| | - Muhammad Zahid
- Department of Internal MedicineHamad General HospitalDohaQatar
- College of Medicine, QU HealthQatar UniversityDohaQatar
- Weill Cornell Medical CollegeDohaQatar
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Kanakaraj L, Mamtani H, Dahale AB, M N, S N, Sinha S, Thippeswamy H. Psychiatric manifestations of neurosyphilis over past two decades: Findings from a tertiary care neuropsychiatric hospital in south India. Asian J Psychiatr 2024; 94:103952. [PMID: 38364749 DOI: 10.1016/j.ajp.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To assess presentation of neurosyphilis with a focus on the psychiatric aspects. METHOD File review of the cases with a positive cerebrospinal fluid venereal disease research laboratory test between 1999 to 2020. RESULTS Medical records of 143 neurosyphilis patients were analysed. Hallucinations, delusions, and catatonia were the commonest psychiatric symptoms. Brain atrophy was the commonest neuroimaging finding. The number of neurosyphilis patients and the proportion with delirium or catatonia declined during the second decade (2010-2020). CONCLUSION Atypical presentation of psychiatric symptoms around the fifth decade, with associated neurological symptoms or brain imaging changes, should prompt evaluation for neurosyphilis.
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Affiliation(s)
- Logesh Kanakaraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Harkishan Mamtani
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Ajit Bhalchandra Dahale
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
| | - Netravathi M
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Nagarathna S
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
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Alves M, Pinheiro Ramos C, Durães D, Mendes S, Gamito A. Neurosyphilis-Induced Folie À Deux: A Case of Prolonged Psychosis. Cureus 2023; 15:e46375. [PMID: 37920639 PMCID: PMC10619995 DOI: 10.7759/cureus.46375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Neurosyphilis presentations can include psychiatric symptoms such as psychosis, mania, depression, or changes in personality. Therefore, it can lead to a misdiagnosis with psychiatric disorders. The diagnosis is particularly difficult in a subset of patients whose psychotic symptoms are developed as a manifestation of the disease later in life. With the aim to highlight the importance of considering neurosyphilis in the differential diagnosis of late psychosis, it is presented the clinical case of a folie à deux from a Portuguese 69-year-old man, who presented symptoms of psychosis in the emergency room, ultimately diagnosed with neurosyphilis. A selective review of the literature was made using the Pubmed database, with "neurosyphilis", "psychosis", "syphilis", and "folie à deux" as keywords. Patient consent was obtained for the use of clinical data. Neurosyphilis represents the most severe consequence of an untreated syphilis infection and there is a need in the scientific community to establish tools to enhance the precision of diagnosis and treatment.
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Affiliation(s)
- Margarida Alves
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, PRT
| | - Cátia Pinheiro Ramos
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, PRT
| | - Diana Durães
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, PRT
| | - Susana Mendes
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, PRT
| | - António Gamito
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, Setúbal, PRT
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Currens L, Sivakumar S, Jun-O'Connell AH, Ionete C, Ghasemi M. Neurosyphilis presenting with focal middle cerebral artery stenosis and acute ischemic stroke: A case report. Radiol Case Rep 2022; 17:1620-1625. [PMID: 35321268 PMCID: PMC8935340 DOI: 10.1016/j.radcr.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 10/28/2022] Open
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He C, Kong Q, Shang X, Duan Y, Cui Y, Wang J, Ci C, Sang H. Clinical, laboratory and brain Magnetic Resonance Imaging (MRI) characteristics of asymptomatic and symptomatic HIV-negative neurosyphilis patients. J Infect Chemother 2021; 27:1596-1601. [PMID: 34330638 DOI: 10.1016/j.jiac.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are few studies concerning the differences between asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS). This study aimed to summarize clinical, laboratory and brain Magnetic Resonance Imaging (MRI) characteristics of HIV-negative patients with ANS and SNS. METHODS Data from 43 HIV-negative patients with ANS and 59 HIV-negative patients with SNS were retrospectively collected from our hospital between December 2012 and December 2018. RESULTS Compared with the ANS group, SNS group had more patients that were male, age≥45 years, had brain MRI abnormalities, and exhibited higher serum/cerebrospinal fluid (CSF) TRUST titer, CSF WBC count, CSF protein concentration (P < 0.05). Multivariate regression analysis revealed that male sex, age ≥45 years and CSF TRUST titer were risk factors for SNS [odds ratio (OR) = 7.946,P = 0.001;OR = 3.757, P = 0.041; OR = 2.713, P = 0.002; respectively]. The brain MRI findings of 78 patients without comorbidities showed that ischemic infarct lesions presented in 17/37 (45.95%) of patients with ANS; infarct ischemic stroke (73.17%) especially multiple cerebral infractions (46.34%), cerebral atrophy (48.78%) were also common presentations in the SNS group. CONCLUSIONS Patients with HIV-negative ANS and SNS presented different clinical, laboratory and brain MRI features. Male sex, age ≥45 years and elevated CSF TRUST titer may have an increased risk of developing neurological symptoms. Brain MRI abnormalities may present prior to clinical symptoms. Multiple cerebral infarctions without explained reasons or cerebral atrophy should alert clinicians the possibility of SNS.
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Affiliation(s)
- Caifeng He
- Department of Dermatology,Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, China; Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Qingtao Kong
- Department of Dermatology,Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, China
| | - Xianjin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Yuanyuan Duan
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yong Cui
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China; Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Chao Ci
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China.
| | - Hong Sang
- Department of Dermatology,Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, China.
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Zhang C, Yue W, Hou S, Cui W, Xiang L. Epilepsy and syphilis: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol 2021; 87:483-490. [PMID: 34219436 DOI: 10.25259/ijdvl_681_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 04/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Epileptic seizures were noted as one of the most overlooked manifestations in syphilis; therefore a few clinicians are concerned about the relationship between epilepsy and syphilis. Our study sought to clarify the prevalence and clinical features of epileptic seizures in patients with syphilis. METHODS We retrieved relevant articles from different databases, using the keywords "syphilis and epilepsy" and then performed statistical analysis to characterize the relationship between these diseases. RESULTS Forty one articles were included in this study: eight described the prevalence of syphilis and epilepsy and the remaining 33 were case reports on syphilis with epileptic seizures. The meta-analysis included 1252 patients with syphilis. The pooled estimate of proportion of prevalence (95% confidence interval) was 0.1384 (0.0955-0.2005), and the proportion and heterogeneity showed different degrees of change among three subgroups. The systematic review included 46 cases of syphilis with epileptic seizures. Thirty two (80%) patients had motor seizures, among whom 20 (62.5%) had tonic-clonic seizures. In addition, 30 (75%) patients had impaired awareness and 18 (45%) had status seizures. Twenty five (62.5%) patients were 35-55 years of age, and 77.5% of the included patients were men. Thirty seven (97.4%) patients were seizure-free after anti-syphilis treatment. LIMITATIONS Research in this field has been conducted for a relatively short period and publication bias may exist. Furthermore, some patients with syphilis and epileptic seizures may not have received a clear diagnosis. CONCLUSION The proportion of prevalence was 0.1384. Most of the included patients were 35-55 years of age and had impaired awareness and motor seizures. Many patients with syphilis and epileptic seizure showed full recovery or the development of minor neurological sequelae, and nearly all patients were seizure-free after timely anti-syphilis treatment.
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Affiliation(s)
- Chao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, China
| | - Shuping Hou
- Department of Dermatovenereology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wanzhen Cui
- Department of Neurology, Tianjin Huanhu Hospital, China
| | - Lei Xiang
- Department of Neurology, Tianjin Huanhu Hospital, China
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Kissani N, Nafia S, Zahlane S, Louhab N. Neurosyphilis: a series of 178 cases at the 3rd-level hospital of Marrakesh (Morocco). Eur J Clin Microbiol Infect Dis 2021; 40:2129-2135. [PMID: 33942164 DOI: 10.1007/s10096-021-04253-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/13/2021] [Indexed: 02/03/2023]
Abstract
Neurosyphilis (NS) is an infection of the central nervous system (CNS), caused by Treponema pallidum. Up to 4-10% of patients with untreated syphilis may develop NS which still constitutes a health challenge. The aim of this study is to analyze epidemiological, clinical, paraclinical, therapeutic, and progression profiles of NS in the south of Morocco. Authors analyzed retrospectively 178 files of patients with neurosyphilis, collected in the Neurology Department of Marrakesh over 25 years from January 1994 to March 2019. In our study, the mean age was 46 years (17-75 years). The number of males was dominant (87.6%). The most common presentation was meningoencephalitis. Four cases were atypical (late congenital syphilis, amyotrophic lateral sclerosis, neurosyphilis associated with neuro-Behcet's disease, and acute polyradiculoneuropathy). All patients had positive TPHA and VDRL serologies in blood; CSF-TPHA was positive in all patients, and CSF-VDRL was positive in 64.0% of patients. CT scan and brain MRI showed cortical atrophy in the majority of cases. One hundred seventy-seven patients were treated with intravenous injection of aqueous penicillin G. Neurosyphilis is still a significant medical problem in developing countries, and its occurrence in HIV infection is the reason for a growing number of new cases in developed countries. Given the frequent atypical manifestations of the disease, screening for neurosyphilis should be considered in all patients with neurological or psychiatric symptoms.
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Affiliation(s)
- Najib Kissani
- Neuroscience Research Laboratory of Marrakech Medical School, Cadi Ayyad University, Marrakesh, Morocco.
- Neurology Department, University Hospital Mohamed VI, Marrakesh, Morocco.
| | - Sanaa Nafia
- Neurology Department, University Hospital Mohamed VI, Marrakesh, Morocco
| | - Safaa Zahlane
- Neurology Department, University Hospital Mohamed VI, Marrakesh, Morocco
| | - Nisserine Louhab
- Neuroscience Research Laboratory of Marrakech Medical School, Cadi Ayyad University, Marrakesh, Morocco
- Neurology Department, University Hospital Mohamed VI, Marrakesh, Morocco
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Mejdoubi A, Khoulali M, Raouzi N, Nasri S, Mebrouk Y, Oulali N, Moufid F. Neurosyphilis revealed by compressive cervical spine syphilitic gumma: a case report. Spinal Cord Ser Cases 2020; 6:56. [PMID: 32606288 PMCID: PMC7324907 DOI: 10.1038/s41394-020-0303-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Neurosyphilis is a sexually transmitted disease secondary to the invasion of the central nervous system by the Treponema pallidum. The spinal syphilitic gumma is rare. CASE PRESENTATION We report a case of extradural cervical spinal syphilitic gumma revealed by spinal cord compression in a 58-year-old male. The epidural lesion was removed via a posterior approach. Histological examination revealed syphilis. Syphilis serologies were positive. Brain MRI showed an associated cerebro-meningeal syphilitic gumma. Antibiotic regime based on aqueous penicillin G was introduced for 14 days. DISCUSSION Currently, there is an increase in the frequency of syphilis and changes in its clinical manifestations. Neurosyphilis can take atypical forms. Spinal syphilitic gumma is a rare manifestation and its association with cerebral involvement is exceptional. Diagnosis is based on serologies in the blood and cerebrospinal fluid. The place of imagery, especially magnetic resonance imaging, is essential. Neurosyphilis should be discussed as a possible differential diagnosis in evaluation of spinal and cerebral lesions.
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Affiliation(s)
- Anasse Mejdoubi
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.
| | - Mohamed Khoulali
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Nabil Raouzi
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Yassine Mebrouk
- Department of Neurology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Noureddine Oulali
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Fayçal Moufid
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
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Singh S, Puranik P, Lin E, Marti M, Liu A. Neurosyphilis in AIDS patient presenting as isolated cranial nerve 6 palsy. Clin Case Rep 2020; 8:1877-1879. [PMID: 33088510 PMCID: PMC7562863 DOI: 10.1002/ccr3.3018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022] Open
Abstract
Early neurosyphilis can occur in an immunocompromised host. It has a widely varied presentation. Isolated CN6 as presenting symptom has not been described.
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Affiliation(s)
| | | | - Ethan Lin
- Department of Family Practice California Hospital Medical Center Los Angeles California USA
| | - Miriam Marti
- Department of Neurology Adventist Health White Memorial Los Angeles California USA
| | - Antonio Liu
- Department of Neurology Adventist Health White Memorial Los Angeles California USA
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Fominykh VV, Frei EA, Brylev LV, Gulyaeva NV. Autoimmune Encephalitis: A Disease of the 21st Century at the Crossroads of Neurology and Psychiatry. NEUROCHEM J+ 2018. [DOI: 10.1134/s1819712418040037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ozturk-Engin D, Erdem H, Hasbun R, Wang SH, Tireli H, Tattevin P, Argemi X, Ouamara-Digue E, Gombos A, Lakatos B, Sırmatel F, Cag Y, Pekok AU, Senbayrak S, Balkan II, Gheno M, Uzun N, Kaya S, Cicek-Senturk G, Şengöz G, Tekin R, Çelen MK, Nayman-Alpat S, Ergen P, Şener A, Agalar C, Köse S, Inkaya AÇ, Kaptan F, Al-Majid F, Savasci U, Vahaboglu H. Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study. Eur J Clin Microbiol Infect Dis 2018; 38:125-134. [PMID: 30368740 DOI: 10.1007/s10096-018-3403-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.
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Affiliation(s)
- Derya Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Hakan Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey
| | - Rodrigo Hasbun
- Department of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, USA
| | - Shu-Hua Wang
- Division of Infectious Diseases, Deparment of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Hulya Tireli
- Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Xavier Argemi
- Department of Infectious Diseases and Clinical Microbiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Enora Ouamara-Digue
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Andrea Gombos
- Department of Infectious Disease and Clinical Microbiology, Saint Laszlo Hospital Budapest, Budapest, Hungary
| | - Botond Lakatos
- Department of Infectious Disease and Clinical Microbiology, Saint Laszlo Hospital Budapest, Budapest, Hungary
| | - Fatma Sırmatel
- Department of Infectious Disease and Clinical Microbiology, Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Umut Pekok
- Department of Infectious Diseases and Clinical Microbiology, Private Erzurum Sifa Hospital, Erzurum, Turkey
| | - Seniha Senbayrak
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ilker Inanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Marie Gheno
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nuray Uzun
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selçuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gönül Cicek-Senturk
- Department of Infectious Disease and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Gönül Şengöz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Saygın Nayman-Alpat
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Canan Agalar
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Sükran Köse
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Education Hospital, İzmir, Turkey
| | - Ahmet Çagkan Inkaya
- Department of Infectious Disease and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Atatürk Training and Research Hospital, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Fahad Al-Majid
- Department of Medicine, Infectious Diseases Division, King Saud University Hospital, Riyadh, Saudi Arabia
| | - Umit Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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Abstract
The body of evidence for mania as a secondary syndrome due to organic diseases is small. The clinical diagnosis and management of these patients are mainly based on clinical experience and on some case reports. Treatment should be focused on both the underlying medical illness and the control of acute symptoms. Mania due to a medical condition is relevant in the clinical setting, and thus more research is needed to add evidence-based recommendations to the currently available clinical knowledge. In this review, we summarize the latest information on the etiology, epidemiology, diagnostic aspects, and management of secondary mania.
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Seo EH, Yang HJ, Kim SH, Park JH, Yoon HJ. Psychotic mania as the solitary manifestation of neurosyphilis. Ann Gen Psychiatry 2018; 17:24. [PMID: 29928290 PMCID: PMC5989352 DOI: 10.1186/s12991-018-0195-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/25/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neurosyphilis remains a diagnostic challenge in current psychiatric practice because of its pleomorphic psychiatric manifestations. Although neurosyphilis can present with a wide range of psychiatric symptoms, psychotic mania as its solitary manifestation is an unusual phenomenon. CASE PRESENTATION A 46-year-old man, with no history of any psychiatric disorder, exhibited abruptly developed symptoms of psychotic mania. He was admitted to a psychiatric ward for further evaluation and treatment. Upon admission, his cognitive function was unimpaired, and the hyperactivity was not severe. Also, no abnormalities were found upon neurological examination and brain magnetic resonance imaging. He was initially diagnosed as bipolar disorder with psychotic features. On the 3rd day after admission, he was confirmed as having neurosyphilis by analysis of cerebrospinal fluid and treated with intravenous penicillin-in combination with blonanserin-an atypical antipsychotic drug. After 2 weeks of treatment, most of the symptoms had abated. CONCLUSIONS The present case emphasizes that patients presenting with atypical psychiatric manifestation should be screened for possible syphilis, particularly in the absence of previous psychiatric history, and suggests that combination of blonanserin with antibiotic therapy may be effective in the treatment of the manic and psychotic symptoms secondary to neurosyphilis.
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Affiliation(s)
- Eun Hyun Seo
- 1Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Hae Jung Yang
- Department of Psychiatry, Chosun University Hospital, Chosun University, Gwangju, Republic of Korea
| | - Sang Hoon Kim
- Department of Psychiatry, Chosun University Hospital, Chosun University, Gwangju, Republic of Korea.,3Department of Psychiatry, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jung Hyun Park
- Department of Psychiatry, Chosun University Hospital, Chosun University, Gwangju, Republic of Korea
| | - Hyung-Jun Yoon
- Department of Psychiatry, Chosun University Hospital, Chosun University, Gwangju, Republic of Korea.,3Department of Psychiatry, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Lee JS, Rhee HY, Yoon SS, Park KC. Neurosyphilis combined with acute anterior thalamic infarction. Neurol Sci 2017; 38:2061-2063. [DOI: 10.1007/s10072-017-3052-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/24/2017] [Indexed: 11/29/2022]
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Njiru E, Abdulkadir J, Kamuren Z, Kigen G. Early neurosyphilis presenting with facial palsy and an oral ulcer in a patient who is human immunodeficiency virus positive: a case report. J Med Case Rep 2017; 11:134. [PMID: 28499407 PMCID: PMC5429523 DOI: 10.1186/s13256-017-1297-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/18/2017] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Neurosyphilis is the tertiary stage of Treponema pallidum infection that involves the central nervous system, which occurs within days or weeks after an initial syphilis infection, especially in immunocompromised patients. The diagnosis of neurosyphilis is quite challenging as it is uncommon and often presents with obscure symptoms since any organ system may be involved. CASE PRESENTATION We describe a case of a 40-year-old African man who is human immunodeficiency virus positive with early neurosyphilis who presented with a stiff neck, headache, confusion, restlessness, and a left-sided chest pain; he did not respond to an empiric treatment of ceftriaxone and fluconazole for meningitis, and tramadol for headache. Ten days after admission, he developed generalized tonic-clonic convulsions; on examination he had ipsilateral facial nerve palsy and an oral ulcer, and responded well to benzathine penicillin treatment. CONCLUSIONS Laboratory diagnosis of neurosyphilis is challenging because to date there is no single laboratory test which is considered sensitive enough for diagnosis of the disease, especially in resource-limited settings. Clinical judgment is still an important part of diagnosis; and neurosyphilis should be considered a diagnostic differential in patients with Human Immunodeficiency Virus presenting with central nervous system involvement and in other high-risk patients.
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Affiliation(s)
- Evangeline Njiru
- Department of Internal Medicine, Moi University School of Medicine, P.O. Box 4606, 30100, Eldoret, Kenya
| | - Jamil Abdulkadir
- Department of Internal Medicine, Moi University School of Medicine, P.O. Box 4606, 30100, Eldoret, Kenya
| | - Zipporah Kamuren
- Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, 30100, Eldoret, Kenya
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, 30100, Eldoret, Kenya.
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Yanhua W, Haishan S, Le H, Xiaomei Z, Xinru C, Ling L, Zhangying W, Dong Z, Yuefen Z, Yan T, Xinni L, Sha L, Yuping N. Clinical and neuropsychological characteristics of general paresis misdiagnosed as primary psychiatric disease. BMC Psychiatry 2016; 16:230. [PMID: 27400713 PMCID: PMC4940705 DOI: 10.1186/s12888-016-0925-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system. General paresis (GP) is a type of neurosyphilis. The main manifestation of general paresis is dementia; however, this is different from the other types of dementia, which can be cured by adequate doses of penicillin in the early stage. Neurosyphilis is the "great imitator" because it can mimic many types of medical disorders. In addition, the manifestations of neurosyphilis are not typical. Psychiatric disorders as a cause of general paresis have become more common due to the use of antibiotics. Patients with a psychiatric manifestation are often misdiagnosed. The purpose of this study was to explore the differences in the clinical and neuropsychological characteristics of general paresis between patients misdiagnosed as having a primary psychiatric disease and patients diagnosed correctly upon seeing a doctor. The results may assist clinicians in the early identification of neurosyphilis with a mental disorder. METHOD The demographic and clinical manifestations, laboratory tests, and neuroimaging and neuropsychological characteristics were analysed in 55 general paresis patients with psychiatric disorders, including 29 patients misdiagnosed as primary psychiatric disease and 26 patients diagnosed as having general paresis after being seen once by a doctor. RESULT All of the patients had positive assay results for cerebral spinal fluid (CSF) Treponema pallidum hemagglutination (TPHA). Only 43.3 % of misdiagnosed patients and 30.8 % of general paresis patients had positive results for the CSF rapid plasma reagin (RPR) test; 96.4 % patients had abnormal neuroimaging. Mood disturbances were the most common psychiatric disorder in the general paresis patients, especially agitation, between the two groups (patients with general paresis who were misdiagnosed as having primary psychiatric disease and patients who had never been misdiagnosed) (p = 0.011). CONCLUSION Our findings reinforce the importance of performing serologic testing for syphilis. This should be a part of the evaluation of patients with psychiatric disorders, especially patients with cognitive impairment. When the syphilis serology is positive, the patient should be examined thoroughly for neurosyphilis by lumbar puncture. Brain imaging could also aid the physician in discriminating these patients from those with a functional mental disorder.
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Affiliation(s)
- Wang Yanhua
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Shi Haishan
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Hou Le
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Zhong Xiaomei
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Chen Xinru
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Li Ling
- Department of Psychiatry, Sun Yat-sen University, Guangzhou Brain Hospital, Guangdong, China
| | - Wu Zhangying
- Department of Psychiatry, Guangzhou Medical University, Guangzhou Brain Hospital, Guangdong, China
| | - Zheng Dong
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Zhang Yuefen
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Tan Yan
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Luo Xinni
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Liu Sha
- Department of Radiology, Guangzhou Brain Hospital, Guangdong, China
| | - Ning Yuping
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China.
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Drago F, Merlo G, Ciccarese G, Agnoletti AF, Cozzani E, Rebora A, Parodi A. Changes in neurosyphilis presentation: a survey on 286 patients. J Eur Acad Dermatol Venereol 2016; 30:1886-1900. [PMID: 27306850 DOI: 10.1111/jdv.13753] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.
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Affiliation(s)
- F Drago
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - G Merlo
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
| | - G Ciccarese
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - A F Agnoletti
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - E Cozzani
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - A Rebora
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - A Parodi
- Di.S.Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
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Abstract
Syphilis has reemerged as an important cause of neurological disease, affecting any part of the neuraxis at any stage of infection. What was once a dwindling diagnosis is now redoubling, particularly in the HIV-positive and in men who have sex with men populations. In the era of antibiotics and HIV coinfection, neurosyphilis presentations are protean, making diagnosis notoriously challenging. Advanced disease may be irreversible, and so early detection and treatment are ideal. Herein, we review recent advances in understanding neurosyphilis.
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Mahanta A, Basumatary LJ, Das M, Goswami M, Kayal AK. Neurosyphilis presenting with rapidly progressive dementia and epilepsia partialis continua. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2015. [DOI: 10.1016/j.injms.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Abkur TM, Ahmed GS, Alfaki NO, O'Connor M. Neurosyphilis presenting with a stroke-like syndrome. BMJ Case Rep 2015; 2015:bcr-2014-206988. [PMID: 25739793 DOI: 10.1136/bcr-2014-206988] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurosyphilis results from infection of the central nervous system (CNS) by Treponema pallidum. Neurosyphilis can occur at any time after initial infection, particularly in immunocompromised patients. We describe a case of a 47-year-old man who presented with mixed dysphasia, right upper motor neuron facial palsy and right hemiparesis. Collateral history from the family revealed slowly progressive cognitive impairment and behavioural changes. Neuroimaging was unremarkable, suggesting a non-vascular aetiology. As there was no clear cause for the presentation, a lumbar puncture was performed and serum samples were sent for syphilis serology. The diagnosis of neurosyphilis was made on the basis of a positive RPR test in cerebrospinal fluid. The patient was treated with benzylpenicillin and made a full recovery, with restoration of cognitive function to baseline.
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Affiliation(s)
- Tarig Mohammed Abkur
- Department of Internal Medicine, University Hospital Limerick, Limerick, Ireland
| | | | - Nidal Osman Alfaki
- Department of Internal Medicine, University Hospital Limerick, Limerick, Ireland
| | - Margaret O'Connor
- Department of Internal Medicine, University Hospital Limerick, Limerick, Ireland
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22
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Kapoor S. Cavernous sinus syndrome: a rare complication of neurosyphilis. Intern Med J 2014; 44:428-9. [PMID: 24754696 DOI: 10.1111/imj.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S Kapoor
- Private Practice, Mechanicsville, Virginia, USA
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23
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Friedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A. Psychosis in neurosyphilis -- clinical aspects and implications. Psychopathology 2014; 47:3-9. [PMID: 23711816 DOI: 10.1159/000350059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization estimates that 10-12 million new syphilis infections occur each year. Without treatment, years to decades after initial infection, 30% of affected individuals may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of this review is to evaluate the research literature examining the psychopathological manifestations of psychosis in association with neurosyphilis. METHOD The authors performed a systematic electronic search for published studies (1995-2012). The following databases were used: Medline, Embase and the Cochrane Library as well as the search engines Scopus and Google Scholar. RESULTS 61 articles were used for detailed analysis. Psychotic symptoms due to neurosyphilis are numerous and can inform differential diagnosis for many psychotic manifestations according to ICD-10 or DSM-IV. CONCLUSION Due to our results, current epidemiological data, and the difficulties in differential diagnosis of neurosyphilis, routine screening tests are still recommended in the psychiatric field. Long-term psychiatric input, with periodic syphilis titre controls, seems indicated in individuals affected by neurosyphilis with psychiatric symptoms. Furthermore, individuals with mental health problems may be at higher risk of acquiring syphilis.
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Affiliation(s)
- F Friedrich
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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24
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Neuropsychiatric disorders secondary to neurosyphilis in elderly people: one theme not to be ignored. Int Psychogeriatr 2013; 25:1513-20. [PMID: 23790068 DOI: 10.1017/s1041610213000896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neurosyphilis (NS) may present with neuropsychiatric disorders characterized by cognitive impairment, personality disorders, and confusion, among others. Very few studies have focused on neuropsychiatric disorders secondary to NS in elderly people. METHOD A retrospective chart review was performed to characterize the psychiatric findings, clinical signs and symptoms, laboratory findings, and brain magnetic resonance imaging results of ten elderly inpatients with NS. RESULTS In these ten patients, the most common presenting symptoms included a wide variety of psychiatric manifestations. The serum rapid plasma regain (RPR) and Treponema pallidum particle agglutination assay (TPPA) of the ten patients were positive, with positive CSF TPPA and RPR rates of 100% and 60%, respectively. In addition, 90% of the patients demonstrated abnormal imaging, including cerebral atrophy, infarct ischemic stroke, and hydrocephalus. CONCLUSIONS Our findings support the importance of serological tests for syphilis as a routine component of the evaluation of patients with clinically evident neurological or psychiatric symptoms. If the serology is positive, all of the patients should be examined with a lumbar puncture. Moreover, psychiatric illnesses secondary to NS in the elderly also deserve medical attention.
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Kamath M, Rizvi M, O'Nions J, Brook G. A complex neurological presentation of syphilis. BMJ Case Rep 2013; 2013:bcr2013200309. [PMID: 23912660 PMCID: PMC3762418 DOI: 10.1136/bcr-2013-200309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Syphilis is a contagious sexually transmitted infection notable for its complex array of systemic presentations. It is caused by the spirochaete Treponema pallidum and although once considered to be a largely historical condition in the UK, the recent rise in incidence makes syphilis increasingly relevant when considering unusual presentations in at-risk patients. The disease has three stages: primary, secondary and tertiary. The tertiary stage is associated with a plethora of neurological features ranging from psychosis to seizure caused by direct invasion of the spirochaete into the central nervous system. Here we describe the case of a 45-year-old man presenting with tonic clonic seizures on a background of balance and visual problems. Following normal examination and routine investigations further serology confirmed a diagnosis of neurosyphilis. The patient was started on appropriate treatment and made an excellent clinical recovery.
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26
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Keith DA, Dodson TB, Kaban LB. Historical review: First facial pain patient admitted to Massachusetts General Hospital, February 1823 and first case series. J Oral Maxillofac Surg 2013; 71:1322-33. [PMID: 23866949 DOI: 10.1016/j.joms.2013.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022]
Abstract
Founded in 1811, the Massachusetts General Hospital recently celebrated its bicentennial. The War of 1812 delayed construction of the building so the first patient actually was admitted to the hospital 10 years later, on September 3, 1821. By 1823, the 60 hospital beds were full. Patient 66 was admitted on February 28, 1823, and his hospital course, as described in the admissions book, was transcribed for the Massachusetts General Hospital bicentennial celebration. That case history is reproduced and a case series of 6 similar patients published in 1828 by Dr John Warren, surgeon-in-chief and a founder of the hospital, is presented. In this report, the authors comment on the diagnosis, treatment, and outcome of these patients in the context of the contemporaneous health care environment and in light of the current knowledge of facial pain disorders. This article was adapted from the authors' commentary for the bicentennial celebration.
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Affiliation(s)
- David A Keith
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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27
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Bekkali N, Oumakhir S, Marcil T, Ghfir M, Sedrati O. An annular patch of the scalp reveals tertiary syphilis. Int J Dermatol 2013; 53:e185-7. [PMID: 23675919 DOI: 10.1111/ijd.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nihal Bekkali
- Department of Dermatology, Mohammed V Military Hospital of Instruction, Rabat, Morocco
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28
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Zhang HL, Lin LR, Liu GL, Zeng YL, Wu JY, Zheng WH, Tong ML, Dong J, Su YH, Liu LL, Yang TC. Clinical spectrum of neurosyphilis among HIV-negative patients in the modern era. Dermatology 2013; 226:148-56. [PMID: 23615173 DOI: 10.1159/000347109] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical spectrum of neurosyphilis (NS) has changed over time. OBJECTIVE To describe the clinical spectrum and characteristics of NS in HIV-negative patients. METHODS A retrospective chart review was performed for 149 in patients with NS. RESULT All patients were >25 years old, including 16.8% asymptomatic for NS, 15.4% with syphilitic meningitis, 24.2% with meningovascular NS, 38.9% with general paresis, 4.0% with tabes dorsalis and 0.7% with gummatous NS. The original misdiagnosis rate was 84.6%. All 149 patients had positive serum Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR). The overall positive rates of cerebrospinal fluid RPR (CSF-RPR) and CSF-TPPA were 57.0 and 89.9%, respectively. CSF pleocytosis and elevated CSF protein were found in 40.3% of patients. Nonspecific abnormal brain magnetic resonance imaging and electroencephalography findings were present in 60.4 and 54.8% of NS patients, respectively. CONCLUSIONS NS has various clinical manifestations, laboratory findings and magnetic resonance imaging and electroencephalography findings, but all studies lack specificity. Every patient with neurological or psychiatric symptoms that are without unambiguous causes should have blood tests for syphilis. When serology proves positive, patients should undergo CSF examination.
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Affiliation(s)
- Hui-Lin Zhang
- Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
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29
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Cherington CC, Ressler SW. 31-year-old woman with chronic daily headache and alopecia. Mayo Clin Proc 2013; 88:206-10. [PMID: 23374623 DOI: 10.1016/j.mayocp.2012.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 09/06/2012] [Accepted: 09/14/2012] [Indexed: 11/23/2022]
Affiliation(s)
- Chad C Cherington
- Mayo School of Graduate Medical Education, Mayo Clinic, Scottsdale, AZ, USA
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30
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Kousoulis AA. Kostas Karyotakis (1896-1928): did the great Greek suicidal poet suffer from syphilis? JOURNAL OF MEDICAL BIOGRAPHY 2012; 20:88-90. [PMID: 22791878 DOI: 10.1258/jmb.2011.011019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Kostas Karyotakis is one of the most important Greek poets. His works reflect his existential, pessimistic and satirical tone. He was born in Tripolis, studied Law and spent most of his life working as a public servant. Since 1922 he was aware that he was suffering from syphilis. The disease seems to be the reason why he never accepted the full love of Maria Polydouri, a Greek lyric poet. Karyotakis' conventional life and his many detachments made him feel depressed, a fact that has led many to believe that a clinical depression caused his suicidal ideation. However, the fear of neurosyphilis appears to be the most decisive factor that led to him committing suicide in Preveza. This view is supported by a poem he wrote about the disease, the words of his contemporaries and his suicidal note.
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Thiebaud PC, Banini O, Lambolez T. Neurosyphilis is a treatable cause of dementia not systematically searched for, but still worth to be considered. Rev Neurol (Paris) 2012; 168:195-6. [DOI: 10.1016/j.neurol.2011.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 05/19/2011] [Accepted: 05/27/2011] [Indexed: 10/15/2022]
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32
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Yao Y, Huang E, Xie B, Cheng Y. Neurosyphilis presenting with psychotic symptoms and status epilepticus. Neurol Sci 2011; 33:99-102. [PMID: 21468681 DOI: 10.1007/s10072-011-0563-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 03/19/2011] [Indexed: 10/18/2022]
Abstract
The widespread use of antibiotics in recent years has considerably modified the clinical features of neurosyphilis. Presently, atypical or masked forms of this disease often occur and obscure diagnosis, despite a thorough history and clinical work-up. Here, we report a patient with neurosyphilis presenting with psychotic symptoms who then developed status epilepticus and left limb weakness. Diffusion-weighted magnetic resonance imaging showed hyperintensity involving the right parietal, occipital and temporal lobes and the thalamus. Subsequent serological and cerebrospinal fluid tests confirmed the diagnosis of neurosyphilis. The coexistence of meningovascular syphilis, syphilitic meningitis, and general paresis resulted in the complex manifestation of this patients' condition, as described here in terms of the unusual presentation, evolution, and final diagnosis.
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Affiliation(s)
- Yuanrong Yao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Anshan Avenue 154, Tianjin 300052, China.
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33
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Kararizou E, Naoumis D, Gkiatas K, Kapaki E, Vassilopoulos D. An unusual presentation of neurosyphilis as a probable migraine. J Headache Pain 2010; 11:543-5. [PMID: 20811763 PMCID: PMC3476221 DOI: 10.1007/s10194-010-0254-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/16/2010] [Indexed: 11/28/2022] Open
Abstract
We describe a case which initially presented as persistent and untreatable probable migraine, which was subsequently diagnosed as neurosyphilis during the clinical evaluation. All symptoms regressed after appropriate treatment. We suggest that the possibility of neurosyphilis should be taken into account in the differential diagnosis of a persistent headache which does not respond to medication.
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Affiliation(s)
- Evangelia Kararizou
- Neurologic Clinic, Neurological Department, Aeginitio Hospital, University of Athens, 72-74 Vass. Sofias Avenue, 115 28, Athens, Greece.
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King BH, Lord C. Is schizophrenia on the autism spectrum? Brain Res 2010; 1380:34-41. [PMID: 21078305 DOI: 10.1016/j.brainres.2010.11.031] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/31/2010] [Accepted: 11/07/2010] [Indexed: 12/31/2022]
Abstract
With the ongoing consideration of the diagnostic criteria for mental disorders that is active in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and International Classification of Diseases (ICD-11) revision processes, it is timely to review the phenomenological overlap between autism and schizophrenia. These disorders have at various times been regarded alternatively as closely related and as non-overlapping and incompatible. Nevertheless, there are several reports in the literature that have described individuals with both autism and schizophrenia, and the broader phenotypes of these disorders clearly intersect. Recent studies reveal theory of mind deficits in both disorders, and mirror neuron impairments also appear to be shared. There also may be similar connectivity deficits emerging in functional imaging studies, and both disorders share several genetic signals that are being identified through detection of copy number variants. Taken together, these data suggest that it may be time to revisit the possibility that these disorders are related.
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Affiliation(s)
- Bryan H King
- University of Washington and Seattle Children's Autism Center, Seattle, WA 98105, USA.
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35
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Cavernous sinus syndrome, an atypical presentation of tertiary syphilis: case report and review of the literature. Clin Neurol Neurosurg 2010; 113:65-7. [PMID: 20884116 DOI: 10.1016/j.clineuro.2010.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 08/10/2010] [Accepted: 08/15/2010] [Indexed: 11/22/2022]
Abstract
Cavernous sinus syndrome is rarely caused by tertiary syphilitic infection. To our knowledge only two other cases of cavernous sinus syndrome caused by syphilis have been reported in the literature. We report a case of a 62-year-old female who presented with a mass in the cavernous sinus, which was initially diagnosed as a meningioma radiologically, necessitating a biopsy for diagnostic confirmation. Clinical features of syphilitic aortitis and subsequent positive neurosyphilis laboratory results lead to the suspicion of a gumma infiltrating the cavernous sinus. Empirical treatment with penicillin in an attempt to defer the need for biopsy led to both significant clinical improvement and radiological resolution. This confirmed the diagnosis of a syphilitic gumma in the cavernous sinus. In this paper we emphasize the rarity of cavernous sinus syndrome as a result of syphilitic infection, highlight the diagnostic difficulties using current serological and radiological measures, and propose treating intracerebral mass lesions in serum positive cases empirically prior to more invasive measures.
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