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Hamill MM, Ghanem KG, Tuddenham S. State-of-the-Art Review: Neurosyphilis. Clin Infect Dis 2024; 78:e57-e68. [PMID: 37593890 DOI: 10.1093/cid/ciad437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/19/2023] Open
Abstract
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. We describe the epidemiology of syphilis in the United States, highlight populations that are markedly affected by this infection, and attempt to estimate the burden of neurosyphilis. We describe the cardinal clinical features of early and late (tertiary) neurosyphilis and characterize the clinical significance of asymptomatic neurosyphilis in the antibiotic era. We review the indications for cerebrospinal fluid (CSF) examination and the performance characteristics of different CSF assays including treponemal and lipoidal antibodies, white cell count, and protein concentration. Future biomarkers and the role of imaging are briefly considered. We review preferred and alternative treatments for neurosyphilis and evidence for their use, including evidence for the use of enhanced intramuscular benzathine penicillin G to supplement intravenous penicillin.
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Affiliation(s)
- Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Yokota Y, Ishihara M, Ninomiya S, Mitsuke K, Kamei S, Nakajima H. Locked-in Syndrome Due to Meningovascular Syphilis: A Case Report and Literature Review. Intern Med 2022; 61:1593-1598. [PMID: 34670896 PMCID: PMC9177359 DOI: 10.2169/internalmedicine.8269-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We herein report a 46-year-old man presenting with locked-in syndrome secondary to meningovascular syphilis. Brain magnetic resonance imaging (MRI) demonstrated multiple acute infarctions in the left ventromedial pons, right basis pontis, and left basal ganglia. His locked-in syndrome was hypothesized to have been caused by thrombosis of the small paramedian branches of the basilar artery due to syphilitic arteritis. This is a unique case of bilateral ventromedial pontine infarction caused by meningovascular syphilis that presented as locked-in syndrome. Meningovascular syphilis should be included in the differential diagnosis of uncommon stroke, particularly in young men.
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Affiliation(s)
- Yuki Yokota
- Department of Neurology, Graduate School of Medicine, Nihon University School of Medicine, Japan
| | - Masaki Ishihara
- Department of Neurology, Graduate School of Medicine, Nihon University School of Medicine, Japan
| | - Satoko Ninomiya
- Department of Neurology, Graduate School of Medicine, Nihon University School of Medicine, Japan
| | - Kazutaka Mitsuke
- Department of Neurology, Graduate School of Medicine, Nihon University School of Medicine, Japan
| | - Satoshi Kamei
- Department of Neurology, Center for Neuro-infection, Ageo Central General Hospital, Japan
| | - Hideto Nakajima
- Department of Neurology, Graduate School of Medicine, Nihon University School of Medicine, Japan
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Liao H, Zhang Y, Yue W. Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis. Front Neurol 2022; 13:862175. [PMID: 35645969 PMCID: PMC9133385 DOI: 10.3389/fneur.2022.862175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Neurosyphilis (NS) is an infection of the central nervous system caused by Treponema pallidum. It mimics various neurological and psychiatric diseases. In recent years, there have been several NS cases that manifest as limbic encephalitis (LE). Therefore, the diagnosis of neurosyphilis in the early stages is difficult. Here, we present a case of an NS patient who presented with LE manifestation. The 62-year-old woman presented with acute clinical manifestations of gibberish speech, poor memory, and seizures. Brain MRI showed abnormal signals on the right medial temporal lobe. In addition, the patient had a positive serum leucine-rich glioma inactivated 1 (LGI1) antibody with a titer of 1:16. Therefore, an initial diagnosis of anti-LGI1 encephalitis was made. However, further tests carried out showed positive rapid plasma reagin (RPR), and treponema pallidum particle agglutination (TPPA) tests both in the serum and the cerebrospinal fluid (CSF). Therefore, uncertainty arose as to whether the patient had both anti-LGI1 encephalitis and NS or whether the LGI1 antibody and LE manifestations were due to the NS. The patient was initiated on the recommended dose of penicillin G sodium. Following treatment, the patient reported a significant improvement in clinical symptoms, normal signals in the right temporal lobe, and a negative serum LGI1 antibody. These findings suggested that NS induced the LE manifestations and the production of the LGI1 antibody. This case demonstrates that testing syphilis in patients with LE is important and positive autoimmune encephalitis (AE) antibodies in NS patients need to be viewed and interpreted with greater caution.
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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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Bremer M, Kadernani YE, Wasserman S, Wilkinson RJ, Davis AG. Strategies for the diagnosis and management of meningitis in HIV-infected adults in resource limited settings. Expert Opin Pharmacother 2021; 22:2053-2070. [PMID: 34154509 DOI: 10.1080/14656566.2021.1940954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The incidence of human immunodeficiency virus-1 (HIV-1) associated meningitis has been declining in the post-combination antiretroviral treatment (ART) era, although survival rates remain low for the common causes like tuberculosis and cryptococcal disease. Diagnosis and treatment of meningitis in HIV-1 is complicated by atypical clinical presentations, limited accuracy of diagnostic tests, access to diagnostic tests, and therapeutic agents in low- and middle-income countries (LMIC) and immune reconstitution inflammatory syndrome (IRIS). AREAS COVERED We provide an overview of the common etiologies of meningitis in HIV-1-infected adults, suggest a diagnostic approach based on readily available tests, and review specific chemotherapeutic agents, host-directed therapies, supportive care, timing of ART initiation, and considerations in the management of IRIS with a focus on resource-limited settings. They identify key knowledge gaps and suggest areas for future research. EXPERT OPINION Evidence-based management of HIV-1-associated meningitis is sparse for common etiologies. More readily available and sensitive diagnostic tests as well as standardized investigation strategies are required in LMIC. There is a lack of availability of recommended drugs in areas of high HIV-1 prevalence and a limited pipeline of novel chemotherapeutic agents. Host-directed therapies have been inadequately studied.
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Affiliation(s)
- Marise Bremer
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory
| | - Yakub E Kadernani
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory
| | - Sean Wasserman
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.,Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Republic of South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.,Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Republic of South Africa.,Department of Infectious Diseases, Imperial College London, London, UK.,Francis Crick Institute, London, UK.,Faculty of Life Sciences, University College London, London, UK
| | - Angharad G Davis
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory.,Francis Crick Institute, London, UK.,Faculty of Life Sciences, University College London, London, UK
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Klein M, Angstwurm K, Esser S, Hahn K, Maschke M, Scheithauer S, Schoefer H, Sturzenegger M, Wildemann B, Weber J. German guidelines on the diagnosis and treatment of neurosyphilis. Neurol Res Pract 2020; 2:33. [PMID: 33225223 PMCID: PMC7669305 DOI: 10.1186/s42466-020-00081-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction In view of the importance of neurosyphilis and the difficulties encountered in diagnosing it, the S1 guideline "Neurosyphilis" has been published by the German Society for Neurology (DGN) in accordance with the stipulations of the Association of the Scientific Medical Societies in Germany (AWMF). The present article is an abridged translation of that German guideline. Main recommendations (a) Neurosyphilis can manifest as early neurosyphilis (meningitis, meningovascular neurosyphilis or syphilitic gummas) or late neurosyphilis (tabes dorsalis, general paresis). (b) The following diagnostic criteria help to establish the presence of probable neurosyphilis (always point iv, accompanied by any two of points i to iii): (i) subacute or chronic neuro-psychiatric symptoms; (ii) increased cerebrospinal fluid (CSF) cell count or signs of blood-CSF barrier disruption; (iii) positive effect of anti-neurosyphilis antibiotic therapy on clinical course and CSF findings; (iv) positive TPHA/TPPA or FTA test in serum. (c) The diagnosis of neurosyphilis is confirmed by the subsequent detection of intrathecal production of antibodies against Treponema pallidum. (d) In neurosyphilis, treatment with intravenous penicillin or ceftriaxone for 14 days is recommended. (e) The following parameters can be used to assess a therapeutic effect: clinical findings, serum VDRL, and CSF cell count. Conclusion The German guideline on the diagnosis and treatment of neurosyphilis is a practical tool to support clinicians in diagnosing and treating patients with neurosyphilis. This article is an abridged translation of this guideline (Klein MW, J.; Angstwurm, K.; Esser, S.; Hahn, K.; Matschke, M.; Scheithauer, S.; Schoefer, H.; Sturzenegger, M.; Wildemann, B. Neurosyphilis, S1-Leitlinie. Deutsche Gesellschaft für Neurologie, Leitlinien für Diagnostik und Thearpie in der Neurologie 2020).
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Affiliation(s)
- Matthias Klein
- Department of Neurology, LMU Klinikum Muenchen, Marchioninistr. 15, 81377 Munich, Germany
| | - Klemens Angstwurm
- Department of Neurology, Universitaetsklinik Regensburg, Universitaetsstr. 84, 93042 Regensburg, Germany
| | - Stefan Esser
- Department of Dermatology, Universitaetsklinikum Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Kathrin Hahn
- Department of Neurology, Charite Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Matthias Maschke
- Department of Neurology, Krankenhaus der Barmherzigen Brueder Trier, Nordallee 1, 54292 Trier, Germany
| | - Simone Scheithauer
- Institute for Hygiene and Infectiology, Universitaet Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Helmut Schoefer
- Dr. Horst Schmidt Kliniken, Aukamm-Allee 33, 65191 Wiesbaden, Germany
| | - Matthias Sturzenegger
- Department of Neurology, Inselspital Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Brigitte Wildemann
- Department of Neurology, Universitaetsklinik Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Jörg Weber
- Department of Neurology, Klinikum Klagenfurt, Feschnigstraße 11, 9020 Klagenfurt am Wörthsee, Austria
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Carmo RLD, Alves Simão AK, Amaral LLFD, Inada BSY, Silveira CF, Campos CMDS, Freitas LF, Bonadio V, Marussi VHR. Neuroimaging of Emergent and Reemergent Infections. Radiographics 2020; 39:1649-1671. [PMID: 31589575 DOI: 10.1148/rg.2019190020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Infectious diseases emerge and reemerge over the years, and many of them can cause neurologic disease. Several factors contribute to the emergence and reemergence of these conditions, including human population growth, an increase in international travel, the geographic expansion of recognized pathogens to areas where they were previously nonendemic, and greater contact with wild animal reservoirs. The antivaccination social movement has played an important role in the reemergence of infectious diseases, especially some viral conditions. The authors review different viral (arboviruses such as dengue, chikungunya, and Zika virus; enterovirus 71; measles; and influenza), bacterial (syphilis, Lyme disease, and listeriosis), and parasitic (Chagas disease) diseases, focusing primarily on their neurologic complications. Although there are several additional infectious diseases with central nervous system manifestations that could be classified as emergent or reemergent, those listed here are the most relevant from an epidemiologic standpoint and are representative of important public health issues on all continents. The infections caused by these pathogens often show a variety of neuroimaging patterns that can be identified at CT and MRI, and radiology is central to the diagnosis and follow-up of such conditions. Given the increasing relevance of emerging and reemerging infections in clinical practice and public health scenarios, radiologists should be familiar with these infections. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Rafael Lourenço do Carmo
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Aylla Keiner Alves Simão
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Lázaro Luís Faria do Amaral
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Bruno Shigueo Yonekura Inada
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Camila Filardi Silveira
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | | | - Leonardo Furtado Freitas
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Victor Bonadio
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
| | - Victor Hugo Rocha Marussi
- From the Department of Neuroradiology, A Beneficência Portuguesa de São Paulo, R. Maestro Cardim 769, São Paulo, SP 01323-001, Brazil
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Cassiani-Miranda CA, Chen X. Neurocognitive disorder due to neurosyphilis: a case report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:202-207. [PMID: 32888665 DOI: 10.1016/j.rcp.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/17/2018] [Accepted: 10/16/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Neurosyphilis is a chronic infectious disease caused by Treponema pallidum that can cause a great variety of neuropsychiatric signs and symptoms, which complicates its diagnosis. CASE DESCRIPTION This case occurred in a 40-year-old man who consulted the Emergency Department because of a convulsion (de novo) which was related to a chronic condition of cognitive impairment and psychosis. The appropriate studies were performed for the diagnosis of neurosyphilis and the recommended treatment was initiated. The patient presented clinical improvement and was discharged. DISCUSSION Positive VDRL serology results and imaging findings of marked cortical atrophy conducted to consider a late-stage parenchymatous neurosyphilis with serious cognitive impairment and associated psychosis. Treatment with crystalline penicillin was formulated, which reduced the intensity of the patient's symptoms; however, the patient's lack of interest to attend the check-ups significantly reduces his chances of an adequate recovery. CONCLUSIONS Neurosyphilis must be suspected in patients with clinically evident neurological or psychiatric symptoms. Analysis of VDRL serology and neuroimaging studies are important as an initial evaluation of the patient and must be complemented with cognitive tests or mental examination to determine the state of cognitive impairment.
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Affiliation(s)
| | - Xueyi Chen
- Semillero de Investigación en Psiquiatría de Enlace-Grupo de Investigación en Neuropsiquiatría, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
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Shang XJ, He CF, Tang B, Chang XL, Ci C, Sang H. Neuroimaging Features, Follow-Up Analyses, and Comparisons Between Asymptomatic and Symptomatic Neurosyphilis. Dermatol Ther (Heidelb) 2020; 10:273-283. [PMID: 32124253 PMCID: PMC7090109 DOI: 10.1007/s13555-020-00361-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Many studies have explored the imaging characteristics of patients with neurosyphilis, but no systematic study has been made on the neuroimaging changes after anti-syphilitic treatment. The purpose of this study was to examine neuroimaging differences before and after treatment, comparing patients with asymptomatic and symptomatic neurosyphilis. Methods A total of 102 patients with neurosyphilis, including 60 cases of symptomatic neurosyphilis and 42 cases of asymptomatic neurosyphilis, were identified between December 2012 and June 2019. Their demographics, medical histories, serological tests of peripheral blood and cerebrospinal fluid, and especially neuroimaging features before and after anti-syphilitic treatment were collected and analyzed. Results The patients presented with variable clinical and neuroimaging features, including cerebral infarction or hemorrhage, atrophy, demyelination, arteritis, encephalitis, and hippocampal sclerosis. A total of 29 neuroradiological re-examinations were performed in 19 patients treated with anti-syphilitic medicine. The results indicated that some patients still presented neuroradiological progression after treatment, including 42.1% showing infarction lesions, 47.4% mild to severe brain atrophy, and 15.8% white matter demyelination. Conclusion The clinical and neuroimaging features of neurosyphilis patients are diverse, and their follow-up neuroimaging continued to show progression even with standardized treatment. Electronic supplementary material The online version of this article (10.1007/s13555-020-00361-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xian-Jin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Cai-Feng He
- Jinling Hospital Department of Dermatology, Nanjing Medical University, Nanjing, 210002, People's Republic of China.,Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Biao Tang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Xiao-Li Chang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Chao Ci
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Hong Sang
- Jinling Hospital Department of Dermatology, Nanjing Medical University, Nanjing, 210002, People's Republic of China.
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Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, Negasheva E, Dolya O, Brylev L, Guekht A. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci 2019; 69:67-73. [PMID: 31427238 DOI: 10.1016/j.jocn.2019.08.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Abstract
The term of neurosyphilis (NS) refers to infection of central nervous system by Treponema pallidum. Classically, it has been divided into early (meningitis, meningovascular) and late forms (general paresis and tabes dorsalis). The availability of penicillin and high sensitivity of Treponema pallidum to this antibiotic has led to a widely held perception about rarity of syphilitic forms with central nervous system involvement. However, patient can exhibit atypical clinical presentation. Recently different clinical cases with autoimmune encephalitis-mimicking presentation or atypical movement disorders were described. In this article we presented clinical case series with different clinical and MRI presentation and discuss diagnostic and treatment challenges. During our screening period at neurological department we revealed 6 NS cases. Three of them have an atypical presentation. The first patient was misdiagnosed as acute disseminated encephalomyelitis, the second patient had hippocampal sclerosis and epileptic seizures. Another patient had cognitive decline and autoimmune encephalitis-like MRI lesions. We put an emphasis on widening of indication for lumbar puncture and NS tests in patients with syphilitic anamnesis and neurological manifestations.
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Affiliation(s)
- A Skalnaya
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - V Fominykh
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia.
| | - R Ivashchenko
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - D Averchenkov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | | | - N Frigo
- Moscow Scientific and Practical Center for Dermatology, Venerology and Cosmetology, Moscow Healthcare Department, Russia
| | - E Negasheva
- Moscow Scientific and Practical Center for Dermatology, Venerology and Cosmetology, Moscow Healthcare Department, Russia
| | - O Dolya
- Moscow Scientific and Practical Center for Dermatology, Venerology and Cosmetology, Moscow Healthcare Department, Russia
| | - L Brylev
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia; Moscow Research and Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Russia
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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Süße M, Hannich MJ, Holbe C, Ruhnau J, Sarnowski B, Dressel A. Intrathecal inflammation in young stroke. Acta Neurol Scand 2019; 140:9-16. [PMID: 30939222 DOI: 10.1111/ane.13094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Correct identification of inflammatory etiologies of stroke is of outmost importance as they require treatment of the underlying disease. Aim of this study was to determine the prevalence of inflammatory changes in cerebrospinal fluid (CSF) observed in young cryptogenic stroke patients. MATERIALS AND METHODS Of 6476 records of patients diagnosed with ischemic stroke, 278 had confirmed ischemia in brain imaging and received lumbar puncture. A total of 122 were classified as young stroke (≤55 years), and 156 were classified as older stroke patients; lumbar puncture in this cohort was indicated due to atypical clinical presentation. RESULTS An infectious etiology was detected in 2.5% of young stroke patients (n = 3: vasculitis due to opportunistic infection, vasculitis due to neuroborreliosis, secondary vasospasm after viral meningitis) and in 1.9% (n = 3) in the older stroke cohort (vasculitis due to neurotuberculosis, septic embolic ischemia, vasculitis post-haemophilus influenza meningoencephalitis). Isolated vasculitis was evident in one patient of the older stroke cohort (0.6%). Non-specific alterations in CSF included increased cell count in 10% in young and in 9.3% in the older stroke cohort. Intrathecal Ig synthesis was present in 3.4% of the younger and in 4% of the older stroke cohort. CONCLUSIONS The prevalence of an infectious etiology in young stroke is modest but slightly higher in comparison with older stroke patients. As brain imaging is not always sufficient for suspecting vasculitis, we recommend implementation of lumbar puncture in young cryptogenic stroke patients. If an infectious disease is present in ischemic stroke, it is of high therapeutic relevance.
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Affiliation(s)
- Marie Süße
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Malte Johannes Hannich
- Institute of Clinical Chemistry and Laboratory Medicine University Medicine Greifswald Greifswald Germany
| | - Christine Holbe
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Johanna Ruhnau
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Bettina Sarnowski
- Departement of Neurology University Medicine Greifswald Greifswald Germany
| | - Alexander Dressel
- Departement of Neurology University Medicine Greifswald Greifswald Germany
- Departement of Neurology Carl‐Thiem Klinikum Cottbus Cottbus Germany
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Memantine Rescues Neurosyphilis-Related Schizophrenic-like Features and Cognitive Deficit. Clin Neuropharmacol 2019; 42:133-135. [PMID: 31135390 DOI: 10.1097/wnf.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Neurosyphilis, an infectious neuroinflammatory disorder, could cause diverse neuropsychiatric symptoms mimicking disorders of schizophrenia and dementia; hence, it is known as the "chameleon of psychiatry." Here, we present a subject with neurosyphilis with schizophrenic features and share the treatment outcome. METHODS A 42-year-old single man had schizophrenic-like features and cognitive dysfunction for 1 year. Neurosyphilis was confirmed by a cerebral spinal fluid study. The brain image revealed multiple punctuated white matter gliosis in the bilateral frontal lobes and old lacunar infarctions in the bilateral basal hippocampus. The neuropsychiatric functions were declined until adjunctive memantine therapy. RESULTS With the add-on therapy of memantine 10 mg daily, the psychotic and dementic symptoms markedly improved, and the patient recovered to the premorbid state in the 2-year follow-up course. CONCLUSIONS Memantine has an adjunctive effect on neurosyphilis-related neuropsychiatric disorder via modulation of the glutamatergic neurotransmission and microglia-induced neuroinflammation.
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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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Hobbs E, Vera JH, Marks M, Barritt AW, Ridha BH, Lawrence D. Neurosyphilis in patients with HIV. Pract Neurol 2018; 18:211-218. [PMID: 29478035 DOI: 10.1136/practneurol-2017-001754] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 01/26/2023]
Abstract
Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.
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Affiliation(s)
- Emily Hobbs
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Jaime H Vera
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Lawson Unit, Royal Sussex County Hospital, Brighton, UK
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew William Barritt
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Hurstwood Park Neurological Centre, Haywards Heath, UK
| | - Basil H Ridha
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Hurstwood Park Neurological Centre, Haywards Heath, UK
| | - David Lawrence
- Lawson Unit, Royal Sussex County Hospital, Brighton, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Fragoso YD. Differential diagnosis of multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317714279. [PMID: 28979790 PMCID: PMC5617098 DOI: 10.1177/2055217317714279] [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: 04/13/2017] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 12/19/2022] Open
Abstract
Improvement of multiple sclerosis (MS) diagnoses leads to earlier and correct disease management. The differential diagnostic workup for MS comprises a large variety of medical conditions. There are general guidelines and criteria for diagnosing MS worldwide, but awareness of regional differences needs to be kept in mind. Latin American patients who are screened for MS diagnoses may require an approach that is not exactly the same as that used for patients in North America, western Europe or Asia. In the present review, the conditions that are important for the differential diagnoses of MS in Latin America are reviewed. They include infections, metabolic diseases, nutritional deficits and other autoimmune conditions that physicians in charge of these patients need to be familiar with.
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Affiliation(s)
- YD Fragoso
- MS Unit, Department of Neurology, Universidade Metropolitana de Santos, SP, Brazil
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16
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Soman S, Bregni JA, Bilgic B, Nemec U, Fan A, Liu Z, Barry RL, Du J, Main K, Yesavage J, Adamson MM, Moseley M, Wang Y. Susceptibility-Based Neuroimaging: Standard Methods, Clinical Applications, and Future Directions. CURRENT RADIOLOGY REPORTS 2017; 5. [PMID: 28695062 DOI: 10.1007/s40134-017-0204-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The evaluation of neuropathologies using MRI methods that leverage tissue susceptibility have become standard practice, especially to detect blood products or mineralization. Additionally, emerging MRI techniques have the ability to provide new information based on tissue susceptibility properties in a robust and quantitative manner. This paper discusses these advanced susceptibility imaging techniques and their clinical applications.
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Affiliation(s)
- Salil Soman
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Rosenberg 90A, 1 Deaconess Road, Boston, MA 02215, Tel: 617-754-2009
| | | | - Berkin Bilgic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, A.A. Martinos Center for Biomedical Imaging 149 13th Street, Room 2.102, Charlestown, MA 02129, Tel: 617-866-8740
| | - Ursula Nemec
- Department of Radiology, Medical University of Vienna, Austria
| | - Audrey Fan
- Department of Radiology, Stanford School of Medicine 300 Pasteur Dr, MC 5105, Stanford, CA94305
| | - Zhe Liu
- Cornell MRI Research Lab, Cornell University, 515 East 71st St, Suite 104, New York, NY 10021, ,
| | - Robert L Barry
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, A.A. Martinos Center for Biomedical Imaging 149 13th Street, Suite 2.301, Charlestown, MA 02129 USA, Tel: 615-801-0795
| | - Jiang Du
- Department of Radiology, UCSD, 200 West Arbor Drive, San Diego, CA 92103-8226, Tel: 619-471-0519
| | - Keith Main
- Principal Scientist (SME), Research Division, Defense and Veterans Brain Injury Center, General Dynamics Health Solutions, 1335 East-West Hwy, Suite 4-100, Silver Spring, MD 20910
| | - Jerome Yesavage
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Mail Code 151-Y, 3801 Miranda Avenue, Palo Alto, California 94304, Phone (650) 852-3287
| | - Maheen M Adamson
- Department of Neurosurgery, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System (PSC/117), 3801 Miranda Avenue (151Y), Palo Alto, CA 94304
| | - Michael Moseley
- Department of Radiology, Stanford School of Medicine, Mail Code 5488, Route 8, Rm PS059, Stanford, CA, 94305-5488, Tel: 650-725-6077
| | - Yi Wang
- Department of Radiology, Cornell Medical School, Department of Biomedical Engineering, Cornell University, 301 Weill Hall, 237 Tower Road, Ithaca, NY 14853, Tel: 646 962-2631
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17
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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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Czarnowska-Cubała M. Neurosyphilis and brain magnetic resonance imaging. Int J Dermatol 2015; 54:863. [DOI: 10.1111/ijd.12865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
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