Neurosyphilis (Nervous System Syphilis)

A nervous system disease that develops when the syphilis pathogen transmitted sexually affects the brain and spinal cord.

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Neurological Infections

This hub page brings together 4 conditions under Neurological Infections. Use it to move from overview content to the relevant disease detail pages.

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1Overview

Quick and clear information for patients

What is this Condition?

Neurosyphilis is a form of syphilis caused by Treponema pallidum that affects the brain and spinal cord. If syphilis is left untreated, the pathogen can damage the nervous system years or even decades later. Neurosyphilis may present with meningitis or stroke-like symptoms in the early stage (first two years) and with dementia, psychiatric symptoms, balance disorders, and lightning-like pain in the late stage (10-30 years later). In some patients, it may be detected only on testing without any symptoms. The incidence of syphilis has been increasing in recent years. Early diagnosis and treatment can prevent or halt nervous system damage.

Symptoms

Stroke-like presentation in young age: sudden weakness, speech disturbance (in case of vascular involvement)

Progressive dementia, memory loss, personality and mood changes

Sudden sharp, lightning-like pain attacks (legs, back, abdomen)

Balance and gait disturbance, increased imbalance with eyes closed

Hearing loss, cranial nerve palsies such as facial palsy

Pupils not reacting to light (Argyll Robertson sign)

Diagnosis Methods

Diagnosis is established by combined evaluation of blood and cerebrospinal fluid tests. Blood screening and confirmatory tests for syphilis are performed. Lumbar puncture showing inflammatory cells and elevated protein in the fluid along with positive CSF-specific syphilis test (CSF VDRL) supports the diagnosis. Brain or spinal cord MRI may show small infarcts in vascular involvement or brain atrophy in late-stage disease. HIV testing is also recommended in all patients with diagnosed syphilis.

Treatment Methods

The accepted treatment is intravenous high-dose penicillin G, typically lasting 10-14 days. For patients with penicillin allergy, desensitization can be performed followed by penicillin administration, or alternative antibiotics (such as ceftriaxone) can be used. A transient reaction with fever and malaise may occur in the first hours after treatment initiation; this usually resolves within a day and the antibiotic is not discontinued. Early treatment can prevent damage; although late-stage damage is usually irreversible, treatment halts progression. Supportive treatments are added for pain, balance, and other symptoms.

Intravenous high-dose penicillin G (10-14 days)

Desensitization or alternative antibiotics such as ceftriaxone for penicillin allergy

Neuropathic pain medications for lightning-like pain

Rehabilitation and supportive treatment for balance, motor, and cognitive deficits

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Lumbar Puncture

Collection of cerebrospinal fluid through a needle in the lower back

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Intracranial Pressure Monitor Placement

Monitor implantation for continuous intracranial pressure monitoring

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External Ventricular Drainage

External Ventricular Drainage procedure

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Endoskopik intraserebral/intraventriküler hematom boşaltımı

Endoskopik intraserebral/intraventriküler hematom boşaltımı procedure

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References

Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Osborn AG, Hedlund GL, Salzman KL. Osborn's Brain: Imaging, Pathology, and Anatomy. 2nd ed. Elsevier; 2018.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Neurosyphilis (Nervous System Syphilis)

Neurological Infections

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Lumbar Puncture

Intracranial Pressure Monitor Placement

External Ventricular Drainage

Endoskopik intraserebral/intraventriküler hematom boşaltımı

References

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Related Treatments

Lumbar Puncture

Intracranial Pressure Monitor Placement

External Ventricular Drainage

Endoskopik intraserebral/intraventriküler hematom boşaltımı

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