Description, Causes and Risk Factors:
Neurosyphilis is a very serious infection that affects the brain and can also affect the spinal cord. It develops when a person has syphilis that isn't treated for years after the initial infection. In fact, a person may have syphilis for 10 to 20 years before neurosyphilis develops. The condition is life threatening, but it does not affect everyone who is diagnosed with syphilis.
There are four types of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis. With the asymptomatic type, there are no recognizable symptoms. The affected person will have signs of the disease in his spinal fluid, however. The meningovascular form does cause symptoms, which include nerve and eye problems. Also, a person with this condition may have an increased risk of stroke, as the blood vessels may be damaged.
A person with tabes dorsalis neurosyphilis has damage to the spinal cord, which gradually worsens. Eventually, the affected person will lose her ability to walk. General paresis is marked by damage to the brain cells, which may cause paralysis as well as seizures and a deteriorating mental state. With this condition, parts of the brain and spinal cord may become inflamed, causing a wide range of neurological issues.
Prognosis can change based on the type of neurosyphilis and how early in the course of the disease people with neurosyphilis get diagnosed and treated. Individuals with asymptomatic neurosyphilis or meningeal neurosyphilis usually return to normal health. People with meningovascular syphilis, general paresis, or tabes dorsalis usually do not return to normal health, although they may get much better. Individuals who receive treatment many years after they have been infected have a worse prognosis. Treatment outcome is different for every person.
Symptoms of neurosyphilis usually include:
Decreased ability to concentrate.
Difficulty speaking or understanding speech.
Tremor of the fingers and lips.
A wide gait.
Numbness or tingling of the hands or feet.
Joint destruction because of lack of sensation (Charcot's joint).
Inability to control urine or stool (urinary or fecal incontinence).
Personality changes, such as confusion and irritability.
The diagnosis of neurosyphilis, or more often the definiteexclusion of neurosyphilis as a clinical possibility,remains a difficult problem. Treponema pallidum,the causative agent, cannot be cultured in vitro andmicroscopic techniques are laborious. Thus, diagnosisdepends on serologic tests and cerebrospinal fluid (CSF)examination. The diagnosis of neurosyphilis can bemade with reasonable certainty if there is an appropriateneuropsychiatric syndrome associated with a positiveCSF Venereal Disease Research Laboratory (VDRL)test.The CSF VDRL when reactive, and in the absenceof substantial contamination of CSF with blood, isdiagnostic of neurosyphilis. The VDRL will be falselypositive only if blood contamination is sufficient totinge the CSF pink.What if the CSF VDRL is negative?CSF studies are reactive in only approximately 70-75%of neurosyphilis cases.CSF fluorescent treponemalantibody absorption (FTA-AB) test may be the onlyserological evidence of neurosyphilis, and carries theadvantage of being highly sensitive. However, a highproportion of cases with a positive FTA-AB in the CSFdid not have neurosyphilis. The primary value of theFTA test in CSF may be to exclude the possibility ofneurosyphilis if the test result is negative. If the CSFVDRL is negative, a positive FTA-ABS in an appropriateclinical setting, associated with raised CSF cell count,protein or IgG index, is a useful method of identifyingneurosyphilis.
Additional tests to look for problems with the nervous system may include:
Head CT scan.
Lumbar puncture ("spinal tap") to acquire a sample for cerebrospinal fluid analysis.
MRI scan of the brain, brainstem, or spinal cord.
The first step in neurosyphilis treatment is preventing syphilis. Since syphilis is a sexually transmitted infection (STI), your best option is to use safe sex practices, which you can discuss with your healthcare provider.
Individuals with neurosyphilis can be treated with penicillin given by vein, or by daily intramuscular injections for 10 - 14 days. If they are treated with daily penicillin injections, individuals must also take probenecid by mouth four times a day. Some medical professionals recommend another antibiotic called ceftriaxone for neurosyphilis treatment. This drug is usually given daily by vein, but it can also be given by intramuscular injection. Individuals who receive ceftriaxone are also treated for 10 - 14 days. People with HIV/AIDS who get treated for neurosyphilis may have different outcomes than individuals without HIV/AIDS.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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