Dementia due to neurosyphilis with persistently negative CSF VDRL

Abstract

A 44-year-old right-handed homosexual man was referred for gradual deterioration of skills as a chef, impairment of memory, and decreased fluency and comprehension of speech. He had prominent personality change from an easygoing nature to irritability and anxiety. Over a year, his mental abilities deteriorated such that he was unable to drive a car, maintain a job, or live independently. He had no prior neurologic, psychiatric, or systemic illness. Episodes of agitation, confusion, and body tremors appeared 1.5 years after onset. Evaluation by a neurologist at that time at another hospital revealed disorientation, disinhibition, poor attention and recall, tremors during handwriting, and motor impersistence. Mini-Mental State Examination score was 23 out of 30. There was diffuse cerebral atrophy on MRI (figure, A), and the EEG was normal. CSF had protein of 97 mg/dL, 1 WBC/mm3, and many oligoclonal bands. CSF Venereal Disease Research Laboratory test (VDRL), CSF 14-3-3 level, serum HIV and Lyme antibody, toxicology screen, thyroid and liver functions, …