Health Encyclopedia

Neurosyphilis

Definition

Neurosyphilis is an infection of the brain or spinal cord. It occurs in persons with untreated syphilis many years after they are first infected.

Causes, incidence, and risk factors

Neurosyphilis occurs about 10 to 20 years after first being infected with syphilis. It is considered a life-threatening complication of syphilis. Not everyone who has syphilis will develop this complication.

There are four different forms of neurosyphilis:

Asymptomatic
Meningovascular
Tabes dorsalis
General paresis

Asymptomatic neurosyphilis occurs before symptomatic syphilis. Signs of the disease may be seen in the spinal fluid, but the person has no symptoms.

Meningovascular neurosyphilis causes nerve and eye problems, among other symptoms. There may be damage to the blood vessels, which can lead to a stroke.

Persons with tabes dorsalis have damage to the spinal cord that slowly gets worse, making them unable to walk.

In general paresis, brain cell damage causes paralysis, tremors, seizures, and mental decline. Inflammation may occur anywhere in the brain or spinal cord and can lead to a number of neurological problems.

Symptoms

Headache
Stiff neck
Irritability
Poor concentration
Mental confusion
Depression
Visual disturbances
Abnormal reflexes
Abnormal gait (walk)
Incontinence
Dementia
Weakness, numbness of lower extremities
Loss of muscle function
Muscle contractions
Muscle atrophy

Note: There may be no symptoms

Signs and tests

Blood tests can be done to detect substances produced by the bacteria that causes syphilis. The oldest test is the VDRL test.

In neurosyphilis, it is important to test the spinal fluid for signs of syphilis. Tests to look for problems with the nervous system may include:

Lumbar puncture and a CSF fluid analysis
Cranial CT scan
MRI scan of the brain, brainstem, or spinal cord
Cerebral angiogram

Treatment

Penicillin is used to treat neurosyphilis. The medicine may be given in various ways.

It may be injected into a vein every day for 10 days, then given into a muscle once a week for 3 weeks.

Or, your may need to take penicillin by mouth 4 times a day, combined with muscle injections -- both for 10 days -- and then taken another form of penicillin injected into a muscle for 3 weeks.

You must have follow-up blood tests at 3, 6, 12, and 24 months to make sure the infection is gone.

For information on treating syphilis, see the following articles:

Expectations (prognosis)

How well a person does depends on the severity of neurosyphilis before receiving treatment.

Complications

The symptoms can get slowly worse.

Calling your health care provider

Call for an appointment with your health care provider if you have had syphilis in the past and now have signs of neurological problems.

Prevention

Prompt diagnosis and treatment of the original syphilis infection can prevent neurosyphilis.

References

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005:2274-2276.

U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med 2004; 2: 362-365.

Review Date:3/5/2007
Reviewed By:Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

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