8/18/2023 0 Comments Argyll robertson pupil bilateralWhile a CSF venereal disease research laboratory (VDRL) test is thought to be highly specific, its sensitivity is debatable, with most published papers in the current era citing a sensitivity in the range of 50–60%. However, the interplay between neuroinvasion and inflammatory markers is complex. Neurosyphilis is often diagnosed with a combination of clinical and CSF findings. So far, there are limited Australian data on neurosyphilis, especially with cerebral gummas. It has raised many controversies surrounding the utility of cerebrospinal fluid (CSF) assays for disease confirmation. The variety of clinical presentations combined with the lack of a gold standard test has made the diagnosis often challenging. ![]() Neurosyphilis, often a late sequelae of untreated syphilis, presents with multiple neurocognitive signs and symptoms, including syncope, memory loss, dementia, vision and hearing impairment, cranial nerve involvement, peripheral neuropathy, and, rarely, cerebral gummas. In Australia, the national update on sexually transmitted diseases demonstrated an increase of 146% in syphilis notifications from 2014 to 2018, predominantly among women. The tertiary stage is characterized by the presence of gumma, a rubbery noncontractile tumor that mainly presents on the skin but can occur in other organs, including the brain. Its disease is broadly categorized into four stages: the primary stage, characterized by the development of a painless ulcer known as a chancre on the genitalia the secondary stage, often seen with disseminated disease, which predominates with cutaneous manifestations and a late early and late latent phase, whereby obvious clinical symptoms have resolved, and laboratory investigations are key to making a diagnosis. It is caused by the spirochete Treponema pallidum and is transmitted horizontally through sexual contact or vertically from mother to baby. Syphilis is a sexually transmitted disease that has been present for centuries. The diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging. His cerebrospinal fluid examination showed a nonreactive venereal disease research laboratory test, and magnetic resonance imaging of the brain revealed a gumma. ![]() He also demonstrated bilateral deafness, tabes dorsalis, and left sixth cranial nerve palsy. Case presentationĪ 77-year-old Caucasian gentleman presented to our hospital repeatedly with multiple episodes of presyncope and cognitive impairment. ![]() ![]() Patients treated with benzylpenicillin for a specific duration often show promising clinical and cognitive improvement, thus emphasizing the need for constant vigilance in our day-to-day practice. A comprehensive history and clinical examination are essential to detect suspicious cases early for further cerebrospinal fluid examination and neuroimaging. This clinical challenge involves early and accurate diagnosis, as neurosyphilis masquerades with various clinical symptoms and is often missed during initial presentation to the hospital. Despite being an Old World disease, the rates of infection continue to rise. Neurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |