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By Joseph R Berger MD

Neurosyphilis is a great imitator, and a clinician must be suspicious about the diagnosis as central nervous system infection may present in multivariate fashions. The abandonment of routine serological screening for syphilis has almost certainly reduced the frequency with which early diagnosis of syphilis is established. Concomitant immunosuppression, as occurs with HIV infection, may alter the clinical expression of syphilis. CSF VDRL cannot be used as the gold standard for diagnosis as it is often negative despite the presence of neurosyphilis. In this article the author details the manifestations, diagnosis, and management of neurosyphilis.

Key Points

  • The spectrum of neurologic manifestations of syphilis is broad.
  • Neurosyphilis is not synonymous with tertiary syphilis. Neurologic manifestations may occur early in the course of infection.
  • The incidence of syphilis in some populations is growing, and the possibility that it is the cause of an underlying neurologic abnormality should not be overlooked.
  • Neurosyphilis is a treatable disorder, but its sequelae may be permanent.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited