This document discusses syphilis, a multi-system disease caused by the bacteria Treponema pallidum that can involve the nervous system. It has various stages and presentations depending on whether it was acquired or congenital. Neurosyphilis can occur in early or late stages and manifest as asymptomatic neurosyphilis, meningitis, meningovascular symptoms, general paresis, or tabes dorsalis. Diagnosis involves serology and CSF tests. Treatment is with penicillin or other antibiotics. Complications can include hydrocephalus, myelitis, and Jarisch-Herxheimer reaction.

1. SYPHILIS
KEERTHI PRIYA MPT NEURO,
ASSISTANT PROFESSOR

2. INTRODUCTION
Syphilis is a multi system relapsing diseases with multi focal
neurological involvement in secondary or late stages.
The areas which gets affected are:
Coverings of brain
Brain parenchyma
Spinal cord

3. EPIDEMIOLOGY
Incidence: 0.47-2/100000
Prevalence : 2%
Risk factors:
Unprotected sex
Oral sex
Homosexuals
Multiple partners

4. ETIOLOGY
Bacteria : Spirochete Treponema Pallidum
Routes Of Transmission:
Venerally
Venrtically
Blood transfusion

5. TYPES
1. Congenital
2. Acquired

6. Sub -Types
CONGENITAL
i. Early
ii. Late
ACQUIRED
i. Early
ii. Late
iii. Latent

7. CLINICAL FEATURES
Early :
 snuffles
Rash
Hepatosplenomegaly
Osteochondritis
CONGENITAL

8. CLINICAL FEATURES
Late:
Hutchinson’s teeth
Saddle nose
Keratitis
Saber shins
Mental retardation
Hydrocephalus
Hearing loss
CONGENITAL

9. CLINICAL FEATURES
PRIMARY: 3-90 days
Painless ulcers
Chancres/ skin lesions
Commonly on genitalia
Rarely on mouth, lips, fingers, tonsils & tongue
ACQUIRED
EARLY

10. CLINICAL FEATURES
SECONDARY: 4-10 wks
 Painless non itchy patches / rashes on palm & sole
Fever
Lymphadenopathy
 Hair loss (patchy)
Weight loss
Mucocutaneous lesions
Flat warty growths on anus/uvula
ACQUIRED
EARLY

11. CLINICAL FEATURES
LATE:
 +ve Serological
asymptomatic
LATENT:
GUMMATOUS: Nodules on skin, mucosa
& viscera
CARDIO: Aortic aneurysm, Aortic
regurgitation, Stenosis of coronary ostia
NEURO: Meninges, Parenchyma, Spinal
cord
ACQUIRED

12. NEURO SYPHILIS
TYPES:
1. Early
2. Late
Early:
 Asymptomatic Neuro Syphilis
 Meningeal Neuro Syphilis
 Meningeo Vascular Neuro Syphilis
Late:
 General Paresis
 Tabes Dorsalis

13. EARLY
Asymptomatic Neuro Syphilis
No signs & symptoms
CSF abnormalities
Meningeal Neuro Syphilis
 Headache
 Vomiting
 Neck stiffness
 Photophobia
 Seizures
 Cranial nerve deficits
Meningeo Vascular
 Stroke
 Vertigo
 Sensory loss
 Spastic weakness
 Muscle atrophy

14. LATE
GENERAL PARESIS:
i. Early
ii. Late
Early
Irritability
Dementia
Personality changes
Sleep disturbances
Late
 Confusion
 Delusions
 Impaired memory &
judgement
 seizures

15. Psychological :
 Depression
 Delirium
 Psychosis
Neurological:
Dysarthria
Intention tremor
Argyll Robertson pupil
Hyperreflexia

16. Tabes Dorsalis
Ataxia
Lancinating pain
Loss of vibration & proprioception
Bladder dysfunction
Charcot joints

17. DIAGNOSIS
Serological
CSF
Lesions
Neuro Imaging

18. TREATMENT
 Penicillin G 3-4 millions 4hrs/ day for 10-14 days IV
Procaine Penicillin 2-4 millions IM & Probenecid 300mg 4 times a day
Ceftriaxone 2gm IV/IM 10-14 days.
Oral doxycycline 200mg 2times in a week
Acetaminophen for complications

19. COMPLICATIONS
 Hydrocephalus
Myelitis
Radiculitis
Jarisch Hershimer Reaction: fever, chills, headache& hypotension

20. REFERNCE
 NEUROLOGY IN CLINICAL PRACTICE BY BRADELY
https://www.ncbi.nlm.nih.gov/books/NBK540979/
https://www.fpa.org.uk/sites/default/files/syphilis-information-and-
advice.pdf

21. ANY QUERY?

22. THANK YOU