Neurosyphilis… A Parkland Epidemic?

We recently had 2 fascinating cases of Neurosyphilis presented at Parkland morning report. The first case depicted a patient with cyclical nausea/vomiting related to tabes dorsalis and autonomic dysfunction. The second patient manifested visual disturbance as her primary complaint. Although considered rare in the modern age, Neurosyphilis is not uncommon at Parkland. In part, this may be due to a steady increase in primary and secondary syphilis over the last decade, especially in men who have sex with men.

Syphilis Stats

Clinical pearls for Neurosyphilis are listed below:

  • Neurosyphilis can occur at any time after initial infection.
  • Neurosyphilis can be classified into early forms and late forms. Early Neurosyphilis includes meningitis, meningovasculitis and ocular disease (almost any part of the eye is susceptible). Late Neurosyphilis involves general paresis, autonomic dysfunction and tabes dorsalis (locomotor ataxia, episodic abdominal pain/nausea/vomiting, Argyll-Robertson Pupil).
  • While a reactive CSF-VDRL establishes the diagnosis of neurosyphilis, a nonreactive test does not exclude the diagnosis. A CSF lymphocyte count >5 cells/microL or a protein concentration >45 mg/dL is consistent with the diagnosis of neurosyphilis, as well.
  • First line treatment includes IV penicillin G for 10 to 14 days