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 Dr Sampurna Roy MD

http://www.histopathology-india.net/dermpath.htm

                        

    Dr  Sampurna Roy  MD

Tertiary syphilis of the central nervous system (neurosyphilis) has many manifestations, which involve the meninges (with reactivation of the infection that began during secondary stage) and the arteries and parenchyma of the cerebral cortex.

Visit: Pathology of Syphilis; Congenital Syphilis ; Bejel ;Yaws

Meningovascular syphilis is characterized by an obliterative endarteritis of the meningeal vessels with subsequent arterial thrombosis and ischemic necrosis in the brain and spinal cord.

Meningitis may also irritate the brain, causing grand mal or focal seizures, and may damage cranial nerves at the base of the brain.    Image Link  

Parenchymatous neurosyphilis is characterized by selective destruction of neurons, a process that leads to “general paresis of the insane”.    Image link - rochester.edu (Paretic neurosyphilis : In paretic neurosyphilis the walls of small vessels are thickened, and variable numbers of lymphocytes surround vessels. There are reduced numbers of neurons and rod microglial forms can be seen. The features, then are those of a smoldering inflammatory process that leads to gradual destruction of neurons, eventually becoming manifest in gross atrophy)

This syndrome starts with gradual loss of higher cognitive functions and progresses through various personality changes to dementia.

Patients show impaired judgment, loss of memory, confusion, disorientation, grandiose but poorly developed delusions, hyperactive reflexes, and optic atrophy.

Inflammation of the dorsal roots causes secondary destruction of the dorsal columns (tabes dorsalis), a disorder characterized by loss of senses of joint position and vibration, wide-based gait, footslap, paresthesias of lower limbs,  impotence, and episodes of intense referred pain (tabetic crisis).

There may also be secondary, degenerative arthritis of one or more large joints (Charcot’s joints).

Sometimes there is simultaneous involvement of the parenchyma of both the spinal cord and the brain (taboparesis), usually preceded by generalized paresis.

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Neurosyphilis in HIV-infected patients.Eur J Clin Microbiol Infect Dis. 1995 Oct;14(10):864-9

The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection.N Engl J Med. 1994 Dec 1; 331(22) :1469-73

Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis.Am J Med. 1992;93 (1):9-12