Neurosyphilis in the modern era: Literature review and case series

•In the antibiotic era neurosyphilis can present with atypical clinical presentation.•Atypical clinical case series with neurosyphilis from Russia were presented.•Neurosyphilis can be mimicker of ADEM, pharmacoresistant epilepsy and autoimmune encephalitis.•Lumbar puncture and serologic tests are ve...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2019-11, Vol.69, p.67-73
Main Authors: Skalnaya, A., Fominykh, V., Ivashchenko, R., Averchenkov, D., Grazhdantseva, L., Frigo, N., Negasheva, E., Dolya, O., Brylev, L., Guekht, A.
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Atypical cases
CSF tests
Female
Humans
Male
Middle Aged
MRI
Neurosyphilis
Neurosyphilis - complications
Neurosyphilis - diagnosis
Neurosyphilis - drug therapy
Treponema pallidum
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Summary:•In the antibiotic era neurosyphilis can present with atypical clinical presentation.•Atypical clinical case series with neurosyphilis from Russia were presented.•Neurosyphilis can be mimicker of ADEM, pharmacoresistant epilepsy and autoimmune encephalitis.•Lumbar puncture and serologic tests are very important point in diagnosis of neurosyphilis. The term of neurosyphilis (NS) refers to infection of central nervous system by Treponema pallidum. Classically, it has been divided into early (meningitis, meningovascular) and late forms (general paresis and tabes dorsalis). The availability of penicillin and high sensitivity of Treponema pallidum to this antibiotic has led to a widely held perception about rarity of syphilitic forms with central nervous system involvement. However, patient can exhibit atypical clinical presentation. Recently different clinical cases with autoimmune encephalitis-mimicking presentation or atypical movement disorders were described. In this article we presented clinical case series with different clinical and MRI presentation and discuss diagnostic and treatment challenges. During our screening period at neurological department we revealed 6 NS cases. Three of them have an atypical presentation. The first patient was misdiagnosed as acute disseminated encephalomyelitis, the second patient had hippocampal sclerosis and epileptic seizures. Another patient had cognitive decline and autoimmune encephalitis-like MRI lesions. We put an emphasis on widening of indication for lumbar puncture and NS tests in patients with syphilitic anamnesis and neurological manifestations.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2019.08.033