Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series

作者:Borges Conrado Regis*; de Almeida Sergio Monteiro; Sue Karen; Alves Koslyk Jessyca Luana; Sato Mario Teruo; Shiokawa Naoye; Ghizoni Teive Helio Afonso
来源:Arquivos de Neuro-Psiquiatria, 2018, 76(6): 373-380.
DOI:10.1590/0004-282X20180054

摘要

Background: During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective: To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods: A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clinicas, Federal University of Parana. Results: Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient's myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. Conclusion: This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.

  • 出版日期2018-6