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Neurosyphilis

Encyclopedia of the Neurological Sciences, Page: 543-548
2014
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Book Chapter Description

Neurosyphilis is the consequence of the invasion of the central nervous system by Treponema pallidum and the associated immunological response. Neurosyphilis presents in variegate fashions. The most common form of neurosyphilis currently diagnosed is asymptomatic neurosyphilis. Typically, serological evidence of syphilis prompts cerebrospinal fluid analysis in the absence of neurological symptoms. Among the symptomatic disorders of neurosyphilis, the earliest to manifest is syphilitic meningitis. Meningovascular syphilis typically occurs 6–7 years after the initial infection. Tabes dorsalis is a parenchymatous form of neurosyphilis and typically has a latency of 15–30 years from the time of infection. The most distinctive and often heralding symptom is lightning-like pains, which may be triggered by touch and most often affect the legs and abdomen. Pupillary abnormalities are observed in more than 90% of patients. General paresis is a manifestation of parenchymatous neurosyphilis and, like tabes dorsalis, usually develops after a long (15–30 years) hiatus from the time of infection. Neurosyphilis should be diagnosed in persons with reactive specific treponemal serologies occurring in association with a reactive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test.

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