ABSTRACT
Neurosyphilis can mimic virtually any psychiatric disorder. Since there are no studies measuring the relationship between its psychiatric manifestations and neuroradiological findings, we performed magnetic resonance imaging (MRI) on 20 newly diagnosed patients with neurosyphilis and 20 healthy volunteers. MRI abnormalities occurred in 13 neurosyphilis patients. These included foci of increased signal intensity of T2-weighted images, and generalized cerebral atrophy. Two control subjects showed minor focal changes. In the neurosyphilis patients, frontal lesions showed statistically significant associations with the overall degree of psychiatric morbidity as measured by the brief psychiatric rating scale (p < 0.05). Temporo-parietal lesions showed a near significant association with cognitive impairment as measured by the Mini mental-state examination (p = 0.06). Atrophy measures correlated significantly with cognitive impairment. The results suggest that the site of brain lesions may be important in determining the nature of the psychiatric symptoms in neurosyphilis.
Subject(s)
HIV Seronegativity , Magnetic Resonance Imaging , Neurosyphilis/diagnosis , Adult , Cognition Disorders/physiopathology , Diagnosis, Differential , Female , Humans , Male , Mental Disorders/diagnosis , Middle Aged , Neurosyphilis/physiopathology , Neurosyphilis/psychology , Parietal Lobe/physiopathology , Psychiatric Status Rating Scales , Retrospective Studies , Temporal Lobe/physiopathologyABSTRACT
To determine the usefulness of cerebrospinal fluid (CSF) tests for syphilis at a large academic hospital, clinical and laboratory data on 644 patients in whom such testing was requested over a 12-month period were analysed. In 198 cases (31%) the Treponema pallidum haemagglutination (TPHA) screening test could not be performed because of insufficient fluid. Thirty-eight of the remaining patients were diagnosed as having active neurosyphilis. Examination of 22 files of patients who had a positive TPHA and fluorescent treponemal antibody absorption (FTA-Abs) test together with a negative CSF Venereal Disease Research Laboratory (VDRL) test revealed that other CSF measures indicating disease activity (CSF protein, cells or IgG index) were not utilised optimally. In 10 (45%) of these patients neurosyphilis was not diagnosed despite either abnormal or incomplete CSF biochemical analysis, indicating that if the CSF VDRL is used as the sole marker for disease activity, some cases of neurosyphilis are likely to be missed.
