NEUROSYPHILIS

1. z
Neurosyphilis and
its Physiotherapy
Management
Muskan Rastogi
Bpt

2. z
INTRODUCTION
 Neurosyphilis is a sexually transmitted disease that affects the
nervous system by Treponema pallidum.
 It has been becoming uncommon disease after the introduction
of modern broad-spectrum antibiotics like penicillin.

3. z
CLINICAL TYPES
 Asymptomatic neurosyphilis
 Meningovascular neurosyphilis
 Tabes Dorsalis
 General paralysis of insane

4. z
1.ASYMPTOMTIC NEUROSYPHILIS
 It is manifested by a reactive non-treponemal CSF
serology(VDRL Test)
 There will be no signs and symptoms of focal neurological
disturbances
 The CSF usually reveals elevated protein levels, lymphocytic
pleocytosis and glucose levels

5. z
2. MENINGOVASCULAR
NEUROSYPHILIS
 It occurs in the second stage of syphilis and effects the meninges and vessels of the
brain.
 Syphilitic endateritis causes infarction which is clinically similar to stroke.
 The luminal narrowing predisposes to cerebrovascular thrombosis, ischemia and
infarction
 The most common artery involved is middle cerebral artery
 The clinical manifestations include headaches, vertigo, insomnia and personality
disorders.
 If the base of the brain is involved, cranial nerve palsies can be evident.
 There may be formation of leptomeningeal granulomas which are avascular in nature
called gumma.

6. z
3. TABES DORSALIS
 It is a slowly progressive parenchymatous degenerative disease involving the
posterior columns and posterior roots of the spinal cord.
 Symptoms include loss of pain sensation, loss of peripheral reflexes, impairment of
vibration and joint position sense and ataxia which is progressive.
 Bladder incontinence and loss of sexual function are common.
 15% of patients experience episodes of excruciating epigastric pain with
associated nausea and vomiting.
 These are 3 stages of Tabes dorsalis 1. Preataxia 2. Ataxia 3. Paralysis
 There will be wide based gait with slapping.
 Charcot joints and trophic ulcers develop in later stages.
 The pupils are bilaterally small and fail to constrict but demonstrate normal
constriction to accommodation

7. z
4. GENERAL PARALYSIS OF INSANE
 It is commonly referred as dementia paralytica
 It occurs approximately 20-30 years after the initial exposure to Treponema pallidum.
 It represents a chronic progressive frontotemporal meningoencephalitis with resultant
ongoing loss of cortical functions.
 There will be insidious onset of psychiatric symptoms of general paresis
 These include loss of interest in work, memory lapse, irritability, unusual giddiness,
apathy, social withdrawal.
 Later stages, the symptoms of schizophrenia, euphoric mania, paranoia, toxic psychosis.
 After approximately 5 years of onset, there will be convulsions.
 Abnormal gait, paresthesias, lightening pains of extremities, loss of proprioception,
Romberg sign positive.

8. z
INVESTIGATIONS
 CSF analysis
 Serological tests
 VDRL test
 Treponomal tests
 Non-treponomal tests
 Radiological examination
 Electrodiagnostic tests

9. z
MEDICAL MANAGEMENT
Penicillin G, administered parenterally, is the preferred drug for
treating persons in all stages of syphilis.

10. z
PRINCIPLES OF PHYSIOTHERAPY
ASSESSMENT
The principles of assessment follow the routine neurological assessment with emphasis
on the following:
 Take history of onset of general or constitutional symptoms like headache, fever,
fatigue, weakness, and dizziness.
 Check the patient about the symptoms like pain, redness in eyes, loss/double vision,
photophobia, ringing of bells I ears, loss of hearing
 Check the musculoskeletal symptoms like neck pain, stiffness, muscle weakness.
 Enquire the patient about the neurological symptoms like headache, dizziness,
muscle weakness, confusion, loss of consciousness, seizures, difficulty in speaking
etc.

11. z
 Obtain the clear personality changes, if any, from family members of the patient.
 Assess the cranial nerves to identify the cranial nerve palsies
 Perform a clear and accurate sensory examination. Usually there will be loss of superficial
and cortical sensations.
 Motor examination reveals the muscle weakness. In case of meningococcal neurosyphilis,
there will be motor dysfunction like stroke-spasticity, synergies, loss of voluntary control
etc.
 Examine the reflexes-hyperreflexia
 Nuchal rigidity testing: Assess for meningeal inflammation by following tests:
Brudzinski’s sign and Joint accentuation maneuver
 Assess for neurological bladder symptoms
 ADL assessment which shows diminished capabilities
 Co-ordination and balance is impaired
 On examination of gait, there will be abnormal gait pattern usually ataxic gait is seen.

12. z
PHYSIOTHERAPY MANAGEMENT
 AIMS
 To educate the patient abouts STD’s.
 To improve the muscle power
 To improve cardiovascular and respiratory endurance
 To improve balance and equilibrium
 To improve co-ordination
 To prevent contractures and deformities
 Early ambulation
 Improve the functional capacity of the patient

13. z
 Plans
 Educate patient on the safety measures and precautions to prevent STD’s
 Advise the patient to avoid multiple sex partners.
 All strengthening exercises are trained depending upon muscle power of the patient
 Proper positioning to prevent contractures and deformities
 Balance and Equilibrium exercises.
 Frenkel’s exercises in various positions
 Deep breathing exercises like pranayama, VMT, spirometry to improve ventilatory
effort.
 Aerobics to improve cardiovascular endurance
 Cycling, swimming exercises promotes endurance
 Early ambulation, if needed suitable supports or splints are advised.