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Syphilis of the nervous system can be different, sometimes its diagnosis is difficult - initially in a patient with syphilis of the nervous system, for example, dementia syndrome may be suspected. CNS syphilis can be treated effectively, but the therapy should be implemented quickly - the changes in the nervous system cannot be reversed.

Syphilis of the nervous system( CNS syphilis ) usually occurs after 10-20 years of untreated disease. This is most often the case, however, syphilitic involvement of the structures of the nervous system can actually occur at any time from the spirochete infection. There are factors that accelerate the onset of CNS syphilis - one of the main such aspects is co-suffering from AIDS or HIV infection. It might seem that syphilis is not common anymore - nothing could be more wrong. Syphilis is a bacterial disease caused by the spirochete pale ( Treponema pallidum ), both from neurologists and dermatologists. The infection occurs as a result of sexual contact, and indeed - the first symptoms of this disease are usually located in the reproductive organs, but this is not always the case. Syphilis - especially if left untreated - tends to affect various body systems, including the nervous system.

CNS syphilis: types

Syphilitic infection of the nervous system can be completely asymptomatic. In such a situation, the deviations can be detected in laboratory tests, however, patients with asymptomatic CNS syphilis do not experience any symptoms at this time. This type of disease usually develops within the first few weeks of pale spirochete infection.

Another form of CNS syphilis ismeningeal syphilis . It causes meningitis, usually accompanied by focal neurological symptoms (such as ataxia or paralysis of the cranial nerves). Meningeal syphilis develops after a few weeks, and sometimes years, of spirochete infection. In general, it is estimated that this form of CNS syphilis may occur in up to 30% of untreated syphilis patients. The more dangerous version of this form of the disease, i.e.meningeal syphilis , develops statistically in about 10% of patients with CNS syphilis. Dangerassociated with meningeal syphilis is because patients with this problem are at an increased risk of stroke.

Much later than the above-mentioned problems, because even after 20-30 years of suffering from syphilis, other types of syphilitic involvement of the central nervous system may appear, i.e. spinal dermatitis and progressive paralysis. Spinal pruritus is defined as a condition in which degeneration and demyelination occur in the posterior cords of the spinal cord and in the nerve roots. Patients with pruritus struggle with problems such as severe and paroxysmal (shooting) pain, ataxia and sensory disturbances. Progressive paralysis, in turn, is a condition caused by chronic inflammation of the meninges and the brain, resulting in impaired cerebral cortex function. In the course of progressive paralysis, there are changes in the behavior of patients (they may become apathetic or, conversely, extremely euphoric), in addition, patients may also develop delusions or features suggesting the development of a dementia disorder.

CNS syphilis: symptoms

A general overview of the symptoms that may appear in different types of CNS syphilis is provided above. However, in each of them, patients may also experience other symptoms of CNS syphilis, which may include:

  • headaches
  • dizziness
  • hearing impairment
  • personality changes
  • behavioral disorders
  • weakening of reflexes
  • mood disorders (in the form of its decrease or increase)
  • urinary incontinence or faecal incontinence
  • hypotension (reduction in muscle tone)
  • optic atrophy and related visual disturbances
  • seizures
  • muscle atrophy
  • neck stiffness
  • nausea
  • vomiting
  • confusion
  • concentration disorders
  • tremors
  • muscle contractures

CNS syphilis: diagnosis

In the diagnosis of CNS syphilis, laboratory tests are primarily used to detect pale spirochete infection. The determinations can be performed both by testing the patient's blood and by assessing the cerebrospinal fluid (obtained by lumbar puncture). Both non-specific tests (such as VDRL or USR tests) as well as specific tests for syphilis (which are FTA-ABS, TPHA or TPI) are used.

However, before the patient is referred for laboratory tests, a neurological examination is first performed. As already mentioned, CNS syphilis can develop even afterseveral decades after the initial infection, therefore, proper diagnosis of this condition can simply be difficult. In addition to the aforementioned neurological deviations, in patients with CNS syphilis, the so-called Argyll-Robertson symptom. This is not a deviation specific to syphilis (it can also be found in patients with multiple sclerosis or neuroborreliosis), but it may lead doctors to diagnose syphilitic involvement of the nervous system. The Argyll-Robertson symptom is that the patient's pupils are narrow, they respond correctly to convergence and alignment, but one of the physiological reflexes, i.e. the reaction of the pupils to light, is absent.

Imaging tests are also used in the diagnosis of CNS syphilis. Usually, patients are referred for computed tomography or for magnetic resonance imaging. Thanks to such imaging examinations, it is possible to detect, for example, atrophy of nervous tissue or ischemic foci.

When CNS syphilis is suspected, diagnostics can be extremely extensive, which results, among others, from from the need to exclude other possible causes of the patient's symptoms. Differential diagnosis may be different in different patients, but most often CNS syphilis should be differentiated from psychiatric disorders (e.g. with dementia or schizophrenia), with multiple sclerosis and neuroborreliosis.

CNS syphilis: treatment

Penicillin antibiotics are used to treat CNS syphilis. They are usually administered intramuscularly, the duration of the treatment is typically 10-14 days. Sometimes patients with syphilitic involvement of the nervous system are also given other preparations, such as, for example, ceftriaxone or probenecid.

CNS syphilis: prognosis

Not every syphilis patient develops nervous system involvement. The greatest risk of this happening is when the patient is not treated for syphilis. However, if a patient develops CNS syphilis, time is of key importance - in the case of, for example, meningeal syphilis, a quick start of administering antibiotics to the patient may avoid the occurrence of permanent neurological complications of spirochete infection. Some problems, such as spinal cord pruritus and progressive paralysis, develop after many years of suffering from syphilis. In patients with such problems, antibiotic treatment is also implemented, but it is not possible to reverse the changes in the nervous system caused by CNS syphilis.

The worst prognosis is for patients suffering from CNS syphilis and HIV infection or AIDS at the same time. In their case, the nervous system is involved in the courseSyphilis can occur much faster, and there have already been reports of such patients whose response to penicillin therapy was lower than in people with a properly functioning immune system.

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Category:

Neurology