![]() There may also or alternatively be evidence of acute encephalitis presenting identically to herpes simplex encephalitis, a manifestation that is increasingly common in the HIV/AIDS demographic 10Ĭlinical features vary depending on the exact structures of the eye that are involved, but most commonly posterior uveitis (including posterior placoid chorioretinitis) or panuveitis are seen and present with progressively worsening visual acuity 4,11,12 This is followed by arteritis of vessels in the subarachnoid space, ultimately leading to ischemic stroke (which may be the presenting feature) of the brain and/or spinal cord (see spinal cord infarction) 1,2,4,9,18 Prodrome of mild clinical features of syphilitic meningitis 4,9 ![]() Occurs months to years after infection 3,4 May be associated with myelitis (acute syphilitic meningomyelitis) resulting in upper motor neuron lesion signs on examination such as spastic paresis and hyperreflexia 7,8 ![]() May be associated with the development of syphilitic gummas and focal pachymeningitis, similar to other granulomatous diseases such as tuberculosis or neurosarcoidosis, that can have clinical features of an intracranial mass (especially if they invade into the brain parenchyma) or spinal cord compression 1,2,4 Occurs weeks to months after infection 3,4Ĭlinical features identical to those of a bacterial leptomeningitis, such as headache, neck stiffness, seizures, cranial neuropathies (especially CN III, VI, VII and VIII), and raised intracranial pressure or hydrocephalus 1,4,18 Patients are asymptomatic and will only have evidence of neurosyphilis in CSF analysis 1,4 This is because patients with HIV and neurosyphilis who do not receive treatment for either tend to develop fatal intercurrent infections and complications of AIDS before the late signs of neurosyphilis are able to manifest 5. However, in the modern era where this disease most often co-exists with HIV, late signs of neurosyphilis are rarely seen 5. In addition to features of neurosyphilis, signs and symptoms of secondary and other forms of tertiary syphilis may also be present 1-6. The clinical presentation is very varied and largely depends on the temporal stage of the disease and the corresponding area of the central nervous system that has been affected. Of all patients who are diagnosed with syphilis and are left untreated, between 5-10% of patients will have evidence of symptomatic neurosyphilis 1. This disease is a rare entity in the current antibiotic era, but when present, tends to be seen in association with HIV or AIDS, affecting approximately 1.5% of that population demographic 1.
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