Neurosyphilis

Abstract

Virtually every general discussion dealing with neurosyphilis at any length opens with remarks confirming the ability of the disease to imitate other disturbances in the central nervous system in nearly every category. It is a useful literary gambit that has the added advantage of being true. These sentiments can be traced directly back to meticulous work at the bedside carried out by Jonathan Hutchinson, Alfred Fournier, and many other great clinicians of the 19th century, and, while we are cautioned properly by E van Thomas 1 to accept some of their sweeping assertations only with reservations, it is nevertheless a fact that no single disease has been responsible for so many different pathologic reactions in the brain and spinal cord as has syphilis. The purpose of this section is to outline briefly the clinical features of the various types of neurosyphilis and to consider the modifications in these states as they are seen in present-day practice. Current treatment recommendations are also given, and the controversies concerning the use and interpretation of serologic and other laboratory tests on blood and cerebrospinal fluid in the management of the disease are described. Because the course of the disease in the central nervous system does not lend itself readily to staging, and the clinical forms commonly overlap and interdigitate, classifications of neurosyphilis are uniformly unsatisfactory to the more compulsive minds of medicine. Nevertheless, the scheme developed by Merritt, Adams, and Solomon, 2,3 and adopted here, is practical and serviceable. It is shown in Table 15-1.