Clinical characteristics and diagnosis of nenrosyphilis: analysis of 36 cases

Abstract

Objective To analyze the clinical characteristics and diagnosis of neurosyphilis. Methods A retrospective study was conducted among 36 patients with neurosyphilis treated in our hospital between February, 2002 and November, 2008. The clinical classification, clinical features, misdiagnosis, laboratory findings of the eerebrospinal fluid (CSF), and findings in magnetic resonance imaging (MRI) of the patients were analyzed. Results The patients aged between 30 and 78 years (mean 48.1 years), and male subjects were more frequently affected than female subjects. Meningovaseular syphilis was the most common type (50%) of the disease, followed by general paresis (27.8%) and asymptomatie neurosyphilis (11.1%). The most common symptoms ofneurosyphilis are mental disorders and dementia, followed by focal neurological dysfunction such as paralysis and dysarthria. Misdiagnoses of neurosyphilis, most frequently as viral encephalitis and cerebrovascular accidents, occurred in 55.6% of the patients. CSF examination revealed increased leukocyte count and protein levels. The positivity rate of Treponema pallidum particle agglutination assay of the CSF was91.7%, significantly higher than that of Venereal Disease Research Laboratory (VDRL) test (55.6%) and CSF-ELISA-TP-IgM test (38.9%) (P<0.05). The MRI findings were diverse in these patients. Conclusion No golden standard has been available for the diagnosis ofneurosyphilis, which has diverse clinical manifestations and nonspecifie MRI findings. The presence of Treponemal antibody in the CSF is highly supportive for the diagnosis, which can be established after a comprehensive analysis of the laboratory and clinical evidences. Key words: Neurosyphilis; Meningovascular syphilis; General paresis