Associates' Presentations
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The Patient With Neurosyphilis

Laurin A. Craig, M.D., Peter Sohnle, M.D. Medical College of Wisconsin, Milwaukee, WI

Case: A 61-year-old Laotian male was admitted with a 3-month history of mental status changes consisting mainly of auditory hallucinations, confusion and paranoid behavior. The patient had no physical complaints, recent illness or new medications. The physical exam revealed a blunted affect and disheveled appearance as well as the absence of typical signs of late-stage syphilis. Further analysis showed seropositivity for VDRL and MHA-TP antibodies, CSF that was VDRl positive with elevated protein, and a normal CT scan. The patient was treated with intravenous aqueous PCN G, however, most of the patient's symptoms persisted, exemplifying how difficult neurosyphilis can be to treat.

Discussion: Neurosyphilis was a more common diagnosis prior to the advent of penicillin, but can still be seen by today's clinicians. It is the natural course of untreated primary and secondary syphilis, a well-known sexually transmitted disease. The diagnostic criterion can be a varied as the clinical presentations of neurological dysfunction, but a definative diagnosis requires the presence of Trepnema pallidum antibodies in the serum. Ear and eye manifestations are frequent and usually asymmetric. The treatment is aqueous penicillin but often requires repeat courses.

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