Clinical Characteristics And Diagnosis And Treatment Of Neurosyphilis Presenting As Diplopia

Objective To analyze the clinical features of neurosyphilis presenting as diplopia so as to help early diagnosis and treatment.Methods A retrospective analysis of 2 cases of neurosyphilis presenting as diplopia diagnosed by clinical and laboratory examinations was focused on their clinical manifestations,and pertinent case reports of neurosyphilis presenting as diplopia from retrieval of Medline,Embase,CMB,CMCC,CNKI,VIP were collected to make a retrospective analysis.Results The clinical features of neurosyphilis presenting as diplopia of our two cases included:(1)2 cases were acute onset and progressive development.(2)Diplopia was key symptom.Other clinical symptoms were not presented.(3)2 cases were inequality of pupils.The affected pupils expanded which light reflection disappeared.Red glass test was used for visual inspection which right eye covered red glass.The level of the same side of the left diplopia was observed.(4)Serum and cerebrospinal fluid(CSF)syphilis antibody reaction manifested positive.CSF protein content and cells in CSF increased.(5) Cranial MRI has on certain specificity.(6)There was high rate of misdiagnosis early.(7)2 cases obtained good curative effect after treatment of syphilis.7 pertinent case reports were collected and the clinical features of neurosyphilis presenting as diplopia included:(1)It is common that gumma syphilis and meningovascular syphilis involved cranial nerve to result diplopia.(2)The oculomotor paralysis is common that manifestation of paralysis is not complete,and unilateral paralysis is common.(3)The nervous system imageology of gumma syphilis and meningovascular syphilis is to change.(4)Cells in CSF increased,and lymphocytes are main cell.CSF protein content increased or not.Serum and cerebrospinal fluid(CSF)syphilis antibody reaction manifested positive or negative.(5)Specific accompanied symptoms and signs were fould except eye symptom.(6)7 cases all were applied of penicillin treatment and got good effect.Conelusion Neurosyphilis presenting as diplopia is often misdiagnosed at first. Important basis of diagnosis depends on medical history,clinical manifestations,laboratory examinations of syphilis and image examinations.The premise of correct diagnosis to diplopia as a major performance of neurosyphilis is correct diagnosis of syphilis and judgement relations between diplopia with neurosyphilis.Penicillin is the first choice for effective treatment.