Neurosyphilis

Neurosyphilis is a symptom complex that occurs with syphilitic damage to the nervous system.

Etiology and pathogenesis. Pale treponema, penetrated through the blood-brain barrier, causes inflammatory changes in the membranes and vessels of the brain and spinal cord; Dorsal dryness is dominated by degenerative changes in the parenchyma of the spinal cord. With the introduction of penicillin in the treatment of syphilis, most forms of neurosyphilis, once one of the most common causes of nervous system damage, have almost completely disappeared from everyday practice. The only exception is acute syphilitic meningitis, which is observed in 1-2% of patients with secondary stage of syphilis. Without penicillinotherapy, the traditional forms of neurosyphilis (meningovascular syphilis, brain gum, dorsal, progressive paralysis) occur in no less than 7% of patients with syphilis.

Symptoms, course. The defeat of the nervous system is observed mainly in the secondary and tertiary periods of syphilis. Acute syphilitic meningitis that occurs with secondary syphilis (3-18 months after infection), along with inflammation of the membranes can be accompanied by damage to the brain and cranial nerves; In cerebrospinal fluid - lymphocytic pleocytosis (100-1000 cells in 1 μl), moderate increase in protein and in half the cases decrease in glucose level. In 25% of patients with secondary syphilis, pleocytosis and an increase in protein in the cerebrospinal fluid are detected in the absence of neurological symptoms (asymptomatic neurosyphilis). In tertiary syphilis (5-10 years after infection), meningovascular syphilis can develop, which is characterized by various forms of chronic damage to the membranes, substance and vessels of the brain and spinal cord (cerebrospinal syphilis, endarteritis with thrombosis of cerebral vessels); In cerebrospinal fluid, lymphocytic pleocytosis up to 100 cells per 1 μl, a moderate increase in protein, an increase in gamma globulin, and a left (lyuetic) type of the Lange reaction curve. Spinal cord, presently extremely rare. Shooting pain, the absence of tendon reflexes on the legs, the loss of deep sensitivity in the legs and the associated atactic gait and Romberg's positive symptom, pelvic disorders and pupillary abnormalities (Argyll Robertson's syndrome) are the main symptoms of tabes dorsalis occurring 15-20 years after infection . In cerebrospinal fluid, in many cases, mild lymphocytic pleocytosis (50-200 cells per 1 cubic millimeter), a slight increase in protein, an increase in gamma globulin, which determines the left type of the Lange reaction curve (from the frown to the paralytic curve); In some cases, the composition of the fluid is normal even in untreated patients. The cases of dorsal arthritis presently occurring are usually abortive.

In the diagnosis of all forms of neurosyphilis, serological tests play a very important role. One should only remember the existence of false positive answers not only in Wasserman's reaction, but also with RIBT and RIF. The frequency of positive (serological) results in blood and cerebrospinal fluid in neurosyphilis varies widely; Only with progressive paralysis, the positive reaction of Wassermann in the cerebrospinal fluid reaches almost 100%.

Treatment is carried out according to special schemes in the form of repeated cycles. The main importance is attached to penicillin.

Forecast. Patients with neurosyphilis are known to respond well to penicillin treatment. The exception is spinal dryness, in which the treatment is practically ineffective, but the hospitality of the clinical picture of the majority of modern cases makes the prognosis for life in such patients favorable.