Clinical Manifestations Of Neurosyphilis

Background:The incidence of syphilis decreased in the last part of the 20th century.But in recent years neurosyphilis has become apparent as there has been an alarming increase in the incidence of syphilis.Since penicillin was introduced,the clinical manifestations of neurosyphilis have changed.The clinical manifestations of neurosyphilis are variable and complicated because of fortuitous antibiotic treatment of unsuspected syphilis or under-treated antibiotic therapy of early syphilis.Because of the emergence of atypical forms that may be unfamiliar to the physician,it is difficult to make the diagnosis.Objective:To describe the clinical spectrum of neurosyphilis,and to improve the recognition of it.Methods:The investigation was based on the retrospective review of cases in Peking Union Medical College Hospital from 1951 to 2015(period A:1951-1980 and period B:1980-2015).112 patients with neurosyphilis were identified.Demographic and clinical features,cerebrospinal fluid(CSF)changes were analyzed.Results:1.In period A,male patients predominated with an average male/female ratio of 2.74:1,the mean age was 49.9 years;in period B,the average male/female ratio of 1.93:1,the mean age was 50.5 years.2.The most frequent clinical patterns in period A were tabes dorsalis(40.8%),meningovascular(33.8%),in period B were tabes dorsalis(29.3%),general paresis(24.4%),meningovascular(19.5%).3.Dyscoria,especially Argyll-Robertson pupil used to be the most common form of neurosyphilis' clinical expression(36.6%)in period A,and other typical manifestations such as VIII cranial nerve involvement diminish significantly in period B(2.4%).On the contrary,psychiatric symptoms and cognitive impairment,which are present in just 28.2%of the patients in period A correspondingly,are present in the vast majority of patients in period B(41.5%).4.In period B,the increase of CSF white cell count and protein were similar to that in period A.Conclusion:Our results show that neurosyphilis is still present nowadays and that its clinical spectrum seems to be changing over time,with a trend to less frequent tabes dorsalis.