Tabes Dorsalis Research Articles

Diagnostic, Therapeutic and Monitoring Approach in Suspected Neurosyphilis: Proposal for a Clinical Guideline

This clinical guideline was designed to serve as a hospital guide in the diagnostic, therapeutic, and monitoring approach to neurosyphilis, considering whether there is positivity or not for the human immunodeficiency virus. Syphilis is a sexually transmitted notifiable disease, known as the great imitator. In around 30% of cases of untreated disease, there is a persistent central nervous system infection. Neurosyphilis is a severe and progressive form of syphilis, which can occur at any stage of the disease, with frequent delays in diagnosis and treatment. It is classified as early neurosyphilis (syphilitic meningitis, meningovascular neurosyphilis, or syphilitic gummas) and late neurosyphilis (syphilitic gummas, general paresis, or tabes dorsalis). The importance of lumbar puncture lies not only in its diagnostic value but also in evaluating the effectiveness of treatment. The treatment of this disease in all stages consists of parenteral penicillin. With this guideline, our aim is to facilitate clinical decision-making in cases of suspected neurosyphilis through a systematized, individualized, and multidisciplinary approach.

Analysis of Neurosyphilis Imaging Methods and Treatment: A Focused Review.

Neurosyphilis, a severe complication of syphilis caused by Treponema pallidum, progresses through multiple stages, including asymptomatic, meningeal, meningovascular, and late parenchymal forms such as syphilitic paresis and tabes dorsalis. Neurosyphilis spreads through sexual contact and from mother to child. Symptoms of neurosyphilis include nausea, cranial nerve deficiencies, and seizures. Diagnosing this condition is particularly challenging due to its varied symptoms, which frequently overlap with other neurological disorders. Current diagnostic approaches primarily rely on cerebrospinal fluid (CSF) analysis and neuroimaging techniques like magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT). The exploration of recent advances in neurosyphilis testing and the expanding role of imaging techniques in tracking treatment efficacy are seen. Penicillin G continues to be the primary treatment, with ceftriaxone serving as an alternative for patients with penicillin allergies. Even though ceftriaxone is less potent than penicillin G, it can still successfully eradicate neurosyphilis in patients. This review seeks to deepen the understanding of neurosyphilis pathophysiology, refine diagnostic accuracy, and inform evidence-based treatment approaches. This will ultimately contribute to improved patient outcomes.

Neurosyphilis patients presenting with ocular motor cranial nerve palsy in the modern antibiotic era: Case series from two centers and review of the literature

BackgroundSyphilis can mimic the clinical features of many neurological disorders and cause ocular motor cranial nerve palsy (OMCNP). This study aims to characterize the clinical features of neurosyphilis patients presenting with OMCNP. Methods In a retrospective study and literature review, demographic data, clinical presentations, laboratory findings, radiological findings, treatment approaches, and outcomes were recorded and analyzed. ResultsOverall, 0.74 % and 1.64 % of patients presenting to two institutes exhibited syphilitic OMCNP, respectively. A total of 32 patients (23 from the literature) were recruited, with a median age of 46 years and a predominance of males (81.3 %). Meningovascular neurosyphilis was diagnosed in 29 patients (90.6 %), and tabes dorsalis was found in 3 patients (9.4 %). Unilateral OMCNP was present in 24 patients (65.5 %). Unilateral sixth nerve palsy was observed in 10 patients (34.5 %), followed by unilateral third nerve palsy in 9 patients (31.0 %), and unilateral multiple OMCNP in 5 patients (17.2 %). A total of 12 patients (41.4 %) presented with isolated OMCNP, and 4 of these individuals developed other neurological deficits during the disease. Pupillary involvement was found in all patients who presented unilateral third nerve palsies. After treatment, 17 patients (58.6 %) achieved complete recovery of ocular motility; 6 patients (20.7 %) achieved partial recovery; 5 patients (17.2 %) remained stable; and 1 patient (3.5 %) became progressive. ConclusionsPatients presenting with OMCNP alone or combined with other cranial nerve deficits should be screened for neurosyphilis, and the standard treatment regimen should be initiated if a diagnosis of neurosyphilis is established.

Novel and characteristic radiological features of neurosyphilis: a case series

BackgroundTreponema pallidum can invade the central nervous system (CNS) early in its infection, causing neurosyphilis. Neurosyphilis typically presents with meningovasculitis in the acute or subacute phase, while tabes dorsalis and dementia paralytica are classical conditions in the later stages. However, syphilis is often misdiagnosed as other conditions such as tumors or autoimmune diseases including vasculitis and encephalitis, which is why the condition is known as “The Great Mimicker.” The increasing incidence of syphilis in recent years emphasizes the importance of early diagnosis and treatment; however, its multiple clinical manifestations impose diagnostic challenges for clinicians because it resembles other diseases. In this case series, we present the impressive manifestations of neurosyphilis through three unique radiological presentations.Case presentationCase 1 details optic nerve involvement in an HIV-positive male, where MRI and fundoscopic findings confirmed syphilitic optic neuritis. Case 2 describes a patient in her pregnancy initially suspected of acoustic neuroma on MRI, later diagnosed with syphilitic gumma affecting the inner ear canal. Case 3 is a young male with clinical features mimicking temporal arteritis, ultimately identified as skull osteomyelitis secondarily causing inflammation of the musculus temporalis and meningitis.ConclusionsThese cases underscore the necessity of considering syphilis in differential diagnoses, given the diversity of its clinical presentations. Radiology plays an important role in avoiding unnecessary interventions. The increasing prevalence of recurrent syphilis imposes diagnostic challenges, emphasizing the importance of the early diagnosis and treatment of neurosyphilis by clinicians.

TABES DORSALIS: IS THE DIAGNOSIS A CHALLENGE NOWADAYS?

Purpose: To present a rare case of neurosyphilis, the tertiary form of syphilitic infection, following adequate but belated treatment and manifesting with a variety of clinical signs and further progression to tabetic neurosyphilis. Known as the "great imitator", neurosyphilis is often misdiagnosed and underestimated. Materials/methods: A 48-year-old male patient was admitted to the Neurology clinic of UMHAT "Dr Georgi Stranski" Pleven, Bulgaria, with progressive neurological deficit including numbness in the lower limbs, imbalance and wide-based gait. The T2W- MRI showed abnormally high longitudinal signals at Th12-L1 level, consistent with transverse myelitis. CSF analysis revealed leucocytic pleocytosis, elevated proteins and normal glucose. The nerve conduction studies confirmed sensory motor polyneuropathy. Results: After treatment with intravenous aqueous crystalline (IV) penicillin, 2 million intravenously every 4 hours for 20 days, the sensory symptoms reduced. The coordination disturbances persisted, but the gate showed moderate improvement. Conclusions: The diagnosis of syphilitic myelitis, known as tabes dorsalis, is always complex, not only because of its rarity but because of its unique clinical presentation with multiple clinical symptoms, mimicking other more common neurological disorders. Though confirmation of the diagnosis needs a lot of laboratory and neuroimaging studies, the option of effective specific treatment is worth all the efforts.

Clinical spectrum of late symptomatic neurosyphilis in China: an 11-year retrospective study

ObjectivesThis study aimed to describe the clinical features of neurosyphilis in Chinese patients in an attempt to find clinical features that are helpful for the early identification of neurosyphilis.MethodsThis retrospective...

Acute Ischaemic Stroke in the Context of Neurosyphilis: How Does Antibiotic Therapy Help, and When Should It Be Given?

Neurosyphilis (NS) refers to a central nervous system infection caused by Treponema pallidum. In recent years, there has been an increasing incidence of syphilis; however, NS is uncommon compared to the era before the discovery of penicillin. Manifestations are usually non-specific, ranging from asymptomatic cases to syphilitic meningitis, meningovascular syphilis, general paresis and tabes dorsalis. Meningovascular syphilis can cause an inflammatory arteritis of cerebral arteries, leading to vascular occlusion and cerebral infarction. We report a case of an ischaemic stroke in a patient with several vascular risk factors, presenting with right hemiparesis, hemihypesthesia and dysarthria. Initial computed tomography with angiography of the head and neck was normal; however, magnetic resonance imaging of the brain revealed a thalamic and internal capsule infarct. Serum T. pallidum antibodies were positive, as well as a rapid plasma reagin test. Cerebrospinal fluid analysis confirmed the diagnosis of neurosyphilis, and the patient was treated with ceftriaxone for 14 days due to a penicillin allergy. Although there is a high prevalence of stroke in patients with NS, this condition is typically underdiagnosed. Untreated NS carries a higher risk of stroke recurrence compared to other risk factors. Therefore, early diagnosis and treatment are essential. This case highlights the importance of considering NS in stroke victims, even in older patients with several additional vascular risk factors, to prevent recurrence and other complications. Neurosyphilis (NS) can occur at any stage of syphilis infection, and it can be asymptomatic or symptomatic, presenting as syphilitic meningitis, meningovascular syphilis, general paresis or tabes dorsalis.Ischaemic strokes are a frequent complication of NS, occurring in 14% of the cases. However, only 19% of the cases are correctly diagnosed.NS should be considered as a potential cause of stroke, even in older patients with several other vascular risk factors. This is essential to prevent future strokes, as well as dementia and other complications.

Enhancing clinical awareness: retrospective analysis of neurosyphilis cases and diagnostic predictors for early recognition and treatment.

This is a retrospective analysis of clinical data from individuals diagnosed with neurosyphilis, aiming to enhance healthcare professionals' understanding of the disease and expedite early diagnosis and intervention. A retrospective analysis was conducted on the clinical records of 50 patients who received a diagnosis of symptomatic neurosyphilis and were admitted to the Neurology Department during the period spanning January 2012 to December 2022. Clinical manifestations encompassed diverse phenotypes, with syphilitic meningitis accounting for 16% of cases, characterized by symptoms such as headache, blepharoptosis, paralysis, blurred vision, and tinnitus. Meningovascular syphilis presented in 36% of cases, exhibiting episodic loss of consciousness, limb numbness, and limb convulsion. Paralytic dementia manifested in 36% of cases, featuring symptoms such as memory loss, sluggish response, and slow movement. Tabes dorsalis was observed in 12% of cases, presenting with weakness, numbness, and staggering. Routine cerebrospinal fluid (CSF) analysis indicated abnormal white blood cell counts in 60% of patients, while biochemical testing revealed abnormal protein content in 52% of patients. Notably, statistically significant differences were observed between patients with interstitial and parenchymatous neurosyphilis (Z = 2.023, P = 0.044) in terms of CSF protein content. Electroencephalogram (EEG) results were abnormal in six patients, and imaging studies unveiled diverse findings in 46 patients. The study highlights the importance of neurological and/or ocular symptoms in diagnosing symptomatic neurosyphilis. Individuals with hypomnesia should be closely monitored for potential neurosyphilis. Integrating clinical manifestations, laboratory tests, EEG, and imaging can reduce misdiagnosis. This comprehensive approach shows promise in improving early identification and management of neurosyphilis.

Neurosyphilis presenting with Guillain–Barre syndrome: a case report

BackgroundSyphilis is associated with a wide variety of systemic presentations, earning it the moniker “The great mimicker”. Neurosyphilis is classically associated with meningovasculitis in the acute-subacute stage and tabes dorsalis and dementia paralytica in later stages. However, one of the less well described presentations include Guillain–Barre Syndrome. This case presents a patient with an ascending polyneuropathy suspicious for Guillain–Barre Syndrome who also had other atypical findings including a truncal sensory loss, optic disc swelling, and rash ultimately found to have neurosyphilis. Electrodiagnostic testing was consistent with demyelination, supporting a diagnosis of neurosyphilis associated Guillain–Barre Syndrome.Case presentationA 37-year-old female presented to the emergency department with a weakness and difficulty swallowing. She described a three-month history of symptoms, initially starting with a persistent headache followed by one month of a pruritic rash on her chest, palms, and soles. Two weeks prior to presentation, she developed progressive weakness in her arms, numbness in her arms and chest, and difficulty swallowing. Neurological exam was notable for multiple cranial neuropathies, distal predominant weakness in all extremities, length-dependent sensory loss, and hyporeflexia. Investigation revealed a positive Venereal Disease Research Laboratory in her cerebrospinal fluid without significant pleocytosis, contrast enhancement in cranial nerves V, VII, and VIII on MRI, and a demyelinating polyneuropathy on electrodiagnostic testing. She was diagnosed with Guillain–Barre syndrome, secondary to neurosyphilis. The patient acutely declined and required intubation, and ultimately made a full recovery after treatment with plasmapheresis and penicillin.ConclusionsThis case describes a clinical entity of syphilitic Guillain–Barre Syndrome and highlights the importance of including syphilis in the differential of any patient presenting with ascending polyradiculopathy, especially given the resurgence of syphilis.

Non-cerebellar ataxias: posterior column-like ataxia and cerebellar-like ataxia

Ataxia is not only due to cerebellar lesions, but also due to non-cerebellar lesions such as those in the brain, spinal cord, dorsal root (DR), peripheral nerve. In this article, optic ataxia is excluded and 'vestibular ataxia' is briefly referred. Non-cerebellar ataxias are generically called sensory ataxia or posterior column ataxia. However, since non-cerebellar lesions, e.g. frontal lobe lesions, may develop "cerebellar-like ataxia" (Hirayama, 2010). At the same time, non-posterior column lesions, e.g. parietal lobe lesion, can show "posterior column-like ataxia". From these viewpoints, I here describe various non-cerebellar ataxia in some disorders such as tabes dorsalis and sensory neuropathies and emphasize a role of a peripheral sensory input to the cerebellum via the DR ganglia and spinocerebellar tract for sensory ataxia because there is the International Consensus (2016) that the ataxia in Miller Fisher syndrome is suggested cerebellar-like clinicophysiologically.

The early history of the knee-jerk reflex in neurology

ABSTRACT Medical interest in the knee-jerk reflex began in about 1875 with simultaneous and independent publications by Wilhelm Heinrich Erb (1840–1921) and Carl Friedrich Otto Westphal (1833–1890) contending that the knee jerk was absent (and the ankle clonus was present) in all clear cases of locomotor ataxia (tabes dorsalis). Physicians in the medical communities of Europe, Great Britain, and North America responded with case and large group studies that tested this contention. These studies revealed the usefulness of the knee jerk and other myotatic reflexes, but also unexpected characteristics. The knee jerk, apparently so simple, proved to be a complex phenomenon depending the strength of the strike on the patella, induced muscle tension, and inhibition from the brain. Was it a reflex with afferent and efferent nerves and an intervening process in the spinal cord, or was it a local phenomenon confined to the muscle itself? Experimental studies directed at the reflex issue investigated latencies from patella strike to leg extension or muscle contraction and compared them with latencies from direct muscle strikes and theoretical calculations based on reflex components. Such studies were unable to resolve the reflex issue during the nineteenth century. The physicians were shown to be limited, like all scientific explorers of the unknown, by their knowledge, methodology, and technology.

270. New Onset Seizure Presented as Neurosyphilis

BackgroundThe term “neurosyphilis” refers to infection of the central nervous system (CNS) by Treponema pallidum. It can occur at any time after initial infection. Early in the course of syphilis, the most common forms of neurosyphilis involve the cerebrospinal fluid (CSF), meninges, and vasculature (asymptomatic meningitis, symptomatic meningitis, and meningovascular disease). Late in disease, the most common forms involve the brain and spinal cord parenchyma (general paralysis of the insane and tabes dorsalis).MethodsA 31-year-old man who suddenly developed a new onset generalized tonic clonic seizure, was admitted to the emergency department. He had no history of epilepsy and denied any vision or gait problems. The brain MRI showed no abnormalities. He had a history of rapid plasma reagent (RPR) titer 1:32 and a positive fluorescent treponemal antibody absorption (FTA-ABS) test in 2017. However, the RPR result was non-reactive when he retested a week later and therefore was not diagnosed with syphilis and did not get treated at that time. His most recent RPR titer was 1:16. HIV serology and other STD tests were all negative. His wife and his 3 kids were negative for syphilis. Due to serological evidence of syphilis and neurological symptoms, we arranged him to get a lumbar puncture to rule out neurosyphilis. ResultsHis CSF study showed positive venereal disease research laboratory (VDRL), WBC cell count 44 cells/ul (lymphocytes 80%, Neutrophil 20%), Glucose 50 mg/dl, Protein 75 mg/dl. Based on the CSF study, he was diagnosed with neurosyphilis and was treated with intravenous Penicillin G 3-4 million units every 4 hours for 14 days, followed by Benzathine Penicillin 2.4million units intramuscularly on day 21. ConclusionThis is an unusual case because his false negative RPR result has hindered the prompt diagnosis and management of syphilis. RPR is a nontreponemal test and therefore it is not always reliable as a diagnostic criteria. False negatives in RPR may occur in certain conditions such as in early primary or in late stage syphilis and prozone phenomenon. This case illustrates the importance of using a reverse sequence algorithm in diagnosing syphilis. Thorough history taking is also crucial in conjunction with serological tests to determine the diagnosis and to ensure appropriate treatment.Disclosures All Authors: No reported disclosures

T. Prout and A. Taylor. Severing the posterior roots in the case of persistent gastralgia in a tabetic. Introspinal neurectomy for intractable tabetic gastralgia. — Journ. of Nervous and Ment. Diseases, 1910, № 7

Patient 50 years old, 7 years old suffers from tabes dorsalis. One of the early symptoms of this disease was severe pain in the stomach, against which the patient was forced to resort, for more than 5 years, to injections of morphine.

N. Willige. Observations on the action of Ehrlich-Hata on neurological and psychiatric material. Uber Erfahrung mit Ehrlich-Hata 606 an psychiatrisch-neurologischen Material.—Münch. med. Wochensch. 1910, № 46

Injections of the drug "606" were made in 35 patients; 5 had repeated injections; 21 of them suffered from progression paralysis, 3 taboparalyse, 5 lues cerebri, 3 tabes dorsalis, 1 lues spinalis, and, finally, in 2 cases the diagnosis could not be established with certainty.

Tabetic Arthropathy

Tabetic Arthropathy (TA) defines bone- and joint-destructive processes associated with neurosensory deficits due to syphilis infection. It occurs at the late stages of the disease, and affects 10% of patients with Tabes Dorsalis. The mean age at diagnosis is 60 years with a predilection for male patients. TA became less common thanks to the early diagnosis of syphilis infection, but its management remains complicated given the severity of injuries and the lack of specific treatment. TA can affect every joint, mainly the knees. Patients usually present with a single painless and swollen joint. Deformities are seen in advanced stages. Plain radiographs and CT findings include subchondral sclerosis, osteophytosis, subluxation, and soft tissue swelling. MRI shows articular destruction with irregularities of articular surfaces, deformation, and intraarticular effusion. It also helps differentiate neuropathic osteoarthropathy from other articular diseases as infection, osteonecrosis, and psoriatic arthritis (Figure 1 and 2).

Alzheimer Plaques visualized by in situ DNA Hybridization with Molecular Beacons specific for Borrelia – a novel histomorphologic application

Background: This case describes a novel application of Molecular Beacons, which are a patented technology, for the detection of DNA in tissue sections from an infectious microbe, namely Borrelia burgdorferi, the etiologic agent of Lyme borreliosis. A 65-year-old man with Alzheimer’s disease and previously well documented spinal fluid neuroborreliosis eight years prior to death is the subject of this report. Neuroborreliosis in its tertiary from has been linked to some cases of Alzheimer’s disease (1. -4.) Findings: Molecular beacons designed from the flagellin b open reading frame (BBO 147) of Borrelia burgdorferi, strain B31 demonstrated positive fluorescein signals indicating successful probe hybridization with discrete 4 sharply demarcated rounded foci within tissue slides from autopsy hippocampus. Conclusions: Molecular beacons, carefully designed to hybridize only with the DNA of a target pathogen (after a comprehensive search of the entire human genome to confer probe specificity) are powerful molecular interrogators for evidence of tissue infection. The implications of the application are far reaching in the study of neurodegenerative diseases which might (like General Paresis and Tabes Dorsalis) be sequelae of chronic bacterial infection in the central nervous system.

Tabes dorsalis in the 19th century. The golden age of progressive locomotor ataxia.

Tabes dorsalis, a late neurological complication of syphilis, is nowadays almost extinct. The path to understanding this disease and its pathophysiology was long and winding, spanning multiple centuries. The 19th century was a crucial period for understanding it. In the first third of the century, German and French physicians defined the semiology of tabes dorsalis, renamed in France "ataxie locomotrice progressive [progressive locomotor ataxia]." Nevertheless, the multiplicity of ancient and recent terms and the description of sometimes unclear nosological concepts (tabes nervosa, tabes spasmodic, nervo-tabes, etc.) were a hindrance to understanding it. Tabes dorsalis was a fertile ground for the description of many clinical signs that have become classics in medicine. No real treatment was available and various unusual therapies were performed. For a long time, the etiology of this disease remained unknown. The link between syphilis and tabes dorsalis was slowly established in the second part of the 19th century from epidemiologic observations. We present an overview of the concept of tabes dorsalis in the medical context of the 19th century and discuss the medical observations of some famous patients suffering from the disease such as Édouard Manet (1832-1883) and Alphonse Daudet (1840-1897).

Neurosyphilis Presenting as Failure to Thrive

Neurosyphilis occurs when the nervous system is affected by the Treponema Pallidum bacterial species. Medical literature describes two clinical stages: early and late. Early can be asymptomatic or show signs of meningitis and meningoencephalitis. Conversely, late presents as parenchymal, vascular abnormalities, tabes dorsalis or syphilitic gumma. Although neurosyphilis is now uncommon, knowledge of key physical exam findings is crucial to its consideration and subsequent diagnosis and management.

Neurosyphilis: Still prevalent and overlooked in an at risk population

Neurosyphilis (NS) presents with a variety of clinical syndromes that can be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the "Top End" of the Australian Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. Patient data (2007-2016) were extracted from hospital records, centralised laboratory data and Northern Territory Centre for Disease Control records. Clinical records of patients with clinically suspected NS were reviewed. A diagnosis of NS was made based on the 2014 US CDC criteria. Results were also recategorized based on the 2018 US CDC criteria. The population of the "Top End" is 185,570, of whom 26.2% are Indigenous. A positive TPPA was recorded in 3126 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 25 (35%) were diagnosed with NS (9 definite, 16 probable). Dementia was the most common manifestation (58.3%), followed by epilepsy (16.7%), psychosis (12.5%), tabes dorsalis (12.5%) and meningovascular syphilis (8.3%). 63% of probable NS cases were not treated appropriately due to a negative CSF VDRL. Despite increased specificity of the 2018 US CDC criteria, 70% of patient in the probable NS group were not treated appropriately. The overall annual incidence [95%CI] of NS was 2.47[1.28-4.31] per 100 000py in the Indigenous population and 0.95[0.50-1.62] in the non-Indigenous population (rate ratio = 2.60 [1.19-5.70];p = 0.017). Neurosyphilis is frequently reported in the NT, particularly in Indigenous populations. Disturbingly, 60% of probable neurosyphilis patients based on the 2014 criteria, and 70% based on the 2018 criteria with were not treated appropriately. It is critical that clinicians should be aware of the diagnosis of NS and treat patients appropriately.

Five-year experience of neurosyphilis cases in a tertiary care hospital in Turkey

Aim: To evaluate retrospectively the cases of syphilis who applied to different clinics of our hospital in the last 5 years and to emphasize the importance of admission screening tests in the diagnosis of neurosyphilis which is a rare but serious form of syphilis. Methods: Sixty-one patients who admitted to different clinics of our hospital between 2013 and 2017 with different clinical manifestations and positive Venereal Disease Research Laboratory (VDRL) and Treponema pallidum microhemagglutination assay (TPHA) tests were recorded and analyzed retrospectively. Results: Both VDRL and TPHA tests were positive in 44 males with a mean age of 57.4 ± 18.4 years and 17 females with a mean age of 65.3 ± 19.1 years. It was found that of the 61 patients who were examined for differential diagnosis of syphilis, 36 (%59) of them were referred from neurology clinic, 15 (25%) from infectious diseases clinic, 7 (12%) from dermatology clinic and 3 (4%) from gynecology clinic. The clinical presentation was venereal chancre in 15 cases, asymptomatic ischemic brain lesions in 17 cases, acute ischemic stroke in 13 cases, movement disorder in three cases, tabes dorsalis in two cases, tendinitis-arthritis in eight cases, Amyotrophic lateral sclerosis (ALS) in one case, Deep venous thrombosis (DVT) in one case, and pulmonary nodule in one case. Conclusions: In conclusion, syphilis is often overlooked in the differential diagnosis in patient with neurological findings. Since neurosyphilis is an easily treatable disease, it should be considered in the differential diagnosis of patients presenting with neurological findings.