PITFALLS IN THE DIAGNOSIS OF NEUROSYPHILIS - CASE REPORT AND LITERATURE REVIEW
Abstract:
Neurosyphilis can affect all the major parts of the nervous system as the meninges, brain,
spinal cord, nerve roots, cerebral and spinal blood vessels. The clinical manifestations are polymorphic
and represent an important diagnostic challenge. The neurological symptomatology of syphilis may
develop within weeks/months of the initial infection or, in some cases, it takes decades to appear. We
present a case of a 64-year-old male patient, with classical vascular risk factors, who presented a
typical symptomatology of right middle cerebral artery stroke, but who developed later, in the next 3
months unusual manifestations as central pain, psychiatric symptomatology (depression and cognitive
impairment) and amyotrophy in the paralyzed upper limb. This manifestation prompted us to perform
additional workup for differential diagnosis. Based on the serum and cerebrospinal fluid serology
results, the diagnosis of neurosyphilis was established. Despite the proper treatment, the evolution was
towards rapid aggravation and death. We would like to highlight the fact that despite the dramatic
decline in the incidence of neurosyphilis since the 20th century, the neurologist need to remain aware of
the clinical presentation, diagnosis and treatment of this disease because new cases are still occurring.
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