Neurosyphilis is the involvement of the central nervous system by Treponema pallidum. It causes various clinical symptoms that are sometimes similar to other better-known neurological diseases. This article aims to give a global clinical vision of this entity, reviewing its forms of presentation and its diagnostic and therapeutic management.
The presentation forms of neurosyphilis are grouped into two: early (asymptomatic, meningeal and meningovascular neurosyphilis) and late (progressive general paralysis and tabes dorsalis). In addition, others of lesser importance have been described, such as gumma, ocular forms, syphilitic amyotrophy or hearing loss.
The diagnosis is complex and is based on the study of the cerebrospinal fluid. Due to the difficulty in making a diagnosis with certainty, different diagnostic criteria have been established, in which serology for T. pallidum plays a fundamental role.
The most effective treatment is penicillin, which may sometimes be ineffective, so subsequent clinical and liquor follow-up is recommended. Finally, the changes in the incidence and clinical presentation are described, as well as the diagnostic difficulties that may occur in HIV-positive patients who also suffer from this disease.
Neurosyphilis is a disease still present today, which must be taken into account as a differential diagnosis in multiple neurological and psychiatric diseases given its clinical polymorphism. This fact, the difficult interpretation of serological tests and its irregular response to the usual treatment represent a difficulty for its management, and for the neurologist, the need to know it in detail.
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