Syphilis

• Occurs in ?1.8% of patients with syphilis

• Traditional categorisation:

o Primary

o Secondary

o Tertiary

• Treponeme invades CNS quite early in disease – it is then a question of whether it manifests.

• Alternative classification for neurosyphilis:

o Asymptomatic vs symptomatic

o Early (1-2 years after primary infection) vs Late

o – evidences only by raised CSF WCC and protein

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• Early or late (typically 1-10 years after infection)

o Meningovascular syphilis

- A form of vasculitis of small or medium size arteries

- Stroke, cranial nerve palsies, meningiusm, progressive myelopathy

• Late neurosyphilis (decades after primary infection)

o General paresis

- Progressive dementia, psychosis, personality change, tremor, dysarthria (with halting speech)

o Tabes dorsalis

- Ataxic gait with loss of proprioception, Argyll Robertson pupils, paraparesis with areflexia in the legs.

Early neurosyphilis
Asymptomatic meningitis	Evidenced only by raised CSF WCC and protein
Symptomatic meningitis	Headache, meningisum, cranial nerve palsies, clindness and deafness, seizures
Early or late (typically 1-10 years after infection)
Meningovascular syphilis	A form of vasculitis of small or medium size arteries Stroke, cranial nerve palsies, meningiusm, progressive myelopathy