Neurosyphilis

Definition:

A slowly progressive and destructive infection of the brain or spinal cord that occurs in untreated syphilis many years after the primary infection.

Causes, incidence, and risk factors:

Neurosyphilis occurs in 15 to 20% of all late or tertiary syphilis infections and is a progressive, life-threatening complication. It occurs in men more often than women, and in whites more often than in blacks. There are 4 different forms of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis.

Asymptomatic neurosyphilis precedes symptomatic syphilis and is present in 15% of those with latent syphilis. In this case, abnormalities may be present in the cerebrospinal fluid, but no symptoms are present.

In meningovascular neurosyphilis, cranial nerve palsies and pupillary abnormalities may be present with a wide variety of symptoms.

In tabes dorsalis, progressive degeneration of the spinal cord occurs causing inability to walk. Incidence of tabes dorsalis is 6 out of 1 million.

In general paresis, paralysis, tremors, seizures, and mental decline occur as a result of damage to brain cells. The incidence of general paresis is 1 out of 1 million people.

Stroke secondary to syphilis affects 2 out of 1 million people. Syphilitic aseptic meningitis affects 2 out of 1 million people.