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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: 21] [Impact Index Per Article: 4.2] [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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