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Neurosyphilis
Neurosyphilis is an infectious lesion of the Central nervous system caused by the penetration of syphilis pathogens into it. It can occur in any period of syphilis. Neurosyphilis is manifested by symptoms of meningitis, meningovascular pathology, meningomyelitis, lesions of the posterior ropes and roots of the spinal cord, progressive paralysis or focal brain damage due to the formation of syphilitic gum in it. Diagnosis of neurosyphilis is based on the clinical picture, data of neurological and ophthalmological examination, MRI and CT of the brain, positive serological reactions to syphilis and the results of the study of liquor. Treatment of neurosyphilis is carried out intravenously with large doses of penicillin.
Until a few decades ago, neurosyphilis was a very common complication of syphilis. However, mass examinations of patients for syphilis, timely detection and treatment of infected persons have led to the fact that modern venereology is less likely to face such a form of disease as neurosyphilis, despite the fact that the incidence of syphilis is steadily growing. Many authors also believe that the decline in cases of neurosyphilis associated with changes in pathogenic characteristics of its causative agent — Treponema pallidum — including a reduction of its neirotropnami.
Classification of neurosyphilis
Latent neurosyphilis has no clinical manifestations, but the study of the patient's cerebrospinal fluid revealed pathological changes.
Early neurosyphilis develops against the background of primary or secondary syphilis, mainly in the first 2 years of the disease. But it can occur within 5 years from the time of infection. Proceeds with the defeat of mainly blood vessels and brain membranes. The manifestations of early neurosyphilis include acute syphilitic meningitis, meningovascular neurosyphilis and syphilitic meningomyelitis.
Late neurosyphilis occurs not earlier than 7-8 years from the moment of infection and corresponds to the period of tertiary syphilis. It is characterized by inflammatory and dystrophic lesions of the brain parenchyma: nerve cells and fibers, glia. To the late forms of neurosyphilis include tabes dorsalis, progressive paralysis, and syphilitic Gumma of the brain.
Symptoms of neurosyphilis
Acute syphilitic meningitis is characterized by symptoms of acute meningitis: severe headache, tinnitus, nausea and vomiting, regardless of food intake, dizziness. Often occurs without raising body temperature. Positive meningeal symptoms: rigidity of muscles of neck, lower symptom Brudzinskogo and Kernig's signs. There may be an increase in intracranial pressure. Neurosyphilis in the form of acute meningitis develops most often in the first few years of syphilis, during its relapse. It may be accompanied by skin rashes or be the only manifestation of a relapse of secondary syphilis.
Meningovascular neurosyphilis develops in syphilitic lesions of the vessels of the brain by the type of endarteritis. Is manifested by acute disruption of blood flow in brain in ischemic or hemorrhagic stroke, a few weeks before which the patient begins to disturb headaches, sleep disturbances, dizziness, personality changes. It is possible for meningovascular neurosyphilis with a violation of cerebrospinal circulation and the development of lower paraparesis, sensitivity disorders and disorders of the pelvic organs.
Syphilitic meningomyelitis occurs with damage to the membranes and substance of the spinal cord. There is a slowly increasing spastic lower paraparesis, accompanied by loss of deep sensitivity and dysfunction of the pelvic organs.
Spinal dryness occurs due to syphilitic inflammatory lesions and degeneration of the posterior roots and spinal cord ropes. This form of neurosyphilis occurs on average 20 years after infection. It is characterized by radiculitis with severe pain syndrome, loss of deep reflexes and deep types of sensitivity, sensitive ataxia, neuro-trophic disorders. With neurosyphilis in the form of spinal dryness, impotence may develop. There are neurogenic trophic ulcers on the legs and arthropathy. Characteristic syndrome Argyll-Robertson — irregular shape constricted pupils that do not react to light. The above symptoms may persist after specific therapy of neurosyphilis.
Progressive paralysis may appear in patients with 10-20-year-old disease. This variant of neurosyphilis is associated with the direct penetration of pale treponem into the brain cells, followed by their destruction. Manifests itself in a gradually increasing personality changes, memory impairment, thought disorder until the occurrence of dementia. Often there are mental disorders such as depressive or manic conditions, hallucinatory syndrome, delusional ideas. Neurosyphilis in the form of progressive paralysis may be accompanied by epileptic seizures, dysarthria, violation of pelvic functions, intentional tremor, decreased muscle strength and tone. Perhaps a combination with the manifestations of tabes dorsalis. Typically, patients with similar symptoms of neurosyphilis die within a few years.
Syphilitic gum is localized most often at the base of the brain, which leads to compression of the roots of the cranial nerves with the development of paresis of the oculomotor nerves, atrophy of the optic nerves, hearing loss, etc.as the gum grows in size, intracranial pressure increases and signs of compression of the brain substance increase. Less often, gum in neurosyphilis is located in the spinal cord, leading to the development of lower paraparesis and dysfunction of the pelvic organs.
Diagnosis of neurosyphilis
The diagnosis of neurosyphilis is made taking into account 3 main criteria: the clinical picture, the positive results of studies on syphilis and the detected changes in the cerebrospinal fluid. The correct assessment of the clinic of neurosyphilis is possible only after a neurologist complete neurological examination of the patient. Important additional information for the diagnosis of neurosyphilis gives vision examination and examination of the fundus, which is carried out by the ophthalmologist.
Laboratory tests for syphilis are used in a complex and, if necessary, repeatedly. These include the RPR test, REEF, RIBT, detection of pale Treponema with the content of skin elements (if any). In the absence of symptoms of compression of the brain, a patient with neurosyphilis is carried out a lumbar puncture. The study of cerebrospinal fluid neurosyphilis detects Treponema pallidum, increased protein content, inflammatory cell count in excess of 20 µl. Conducting a REEF with liquor, as a rule, gives a positive result.
MRI of the brain and CT of the brain (or spinal cord) with neurosyphilis detect mainly nonspecific pathological changes in the form of thickening of the meninges, hydrocephalus, atrophy of the brain substance, heart attacks. With their help, it is possible to identify the localization of gum and differentiate neurosyphilis from other similar diseases in the clinic.
Differential diagnosis of neurosyphilis is carried out with meningitis of other Genesis, vasculitis, brucellosis, sarcoidosis, borreliosis, tumors of the brain and spinal cord, etc.
Treatment of neurosyphilis
Therapy of neurosyphilis is carried out in stationary conditions by intravenous administration of large doses of penicillin for 2 weeks. Intramuscular penicillin therapy does not provide sufficient concentration of antibiotic in cerebrospinal fluid. Therefore, when failing intravenous therapy intramuscular administration of penicillins combine with taking probenecid, which inhibits the excretion of penicillin by the kidneys. In patients with neurosyphilis, allergic to penicillin, Ceftriaxone is used.
In the first day of treatment of neurosyphilis may occur temporary worsening of neurological symptoms, accompanied by a rise in body temperature, intense headache, tachycardia, hypotension, arthralgia. In such cases, penicillin therapy of neurosyphilis is supplemented with the appointment of anti-inflammatory and corticosteroid drugs.
The effectiveness of treatment is evaluated by regression of symptoms of neurosyphilis and improvement of cerebrospinal fluid. Control of treatment of patients with neurosyphilis is carried out for 2 years by examining the cerebrospinal fluid every six months. The emergence of new neurological symptoms or the growth of old, as well as the persisting cytosis in the liquor are indications for repeated treatment of neurosyphilis.
Sousres:
https://abuse-drug.com/disease/syphilis/syphilis-symptoms
https://www.ninds.nih.gov/Disorders/All-Disorders/Neurosyphilis-Information-Page
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