Infectious damage to the central nervous system due to the penetration of syphilis pathogens into it. It can occur during any period of syphilis. Neurosyphilis is manifested by symptoms of meningitis, meningovascular pathology, meningomyelitis, lesions of the posterior cords and roots of the spinal cord, progressive paralysis or focal lesions of the brain due to the formation of syphilitic gum in it. Diagnosis of neurosyphilis is based on the clinical picture, data from neurological and ophthalmological examinations, MRI and CT of the brain, positive serological reactions to syphilis, and the results of a CSF study. Treatment of neurosyphilis is carried out intravenously with large doses of penicillin preparations.
General information
Until a few decades ago, neurosyphilis was a very common complication of syphilis. However, mass examinations of patients for syphilis, the timely identification and treatment of infected individuals have led to the fact that modern venereology is increasingly less likely to encounter such a form of the disease as neurosyphilis, despite the fact that the incidence of syphilis is steadily increasing. Many authors also believe that a decrease in the incidence of neurosyphilis is associated with a change in the pathogenic characteristics of its causative agent - treponema pallidum - including a decrease in its neurotropicity.
Classification of neurosyphilis
Latent neurosyphilis does not have any clinical manifestations, but the examination of the patient's cerebrospinal fluid reveals pathological changes.
Early neurosyphilis develops against the background of primary or secondary syphilis, mainly in the first 2 years of the disease. But it can occur within 5 years from the time of infection. It proceeds with damage mainly to the vessels and meninges of the brain. Manifestations of early neurosyphilis include acute syphilitic meningitis, meningovascular neurosyphilis, and syphilitic meningomyelitis.
Late neurosyphilis occurs no earlier than 7-8 years from the moment of infection and corresponds to the period of tertiary syphilis. It is characterized by inflammatory-dystrophic lesions of the brain parenchyma: nerve cells and fibers, glia. Late forms of neurosyphilis include tabes dorsum, progressive paralysis and syphilitic gum of the brain.
Symptoms of neurosyphilis
Acute syphilitic meningitis characterized by symptoms of acute meningitis: severe headache, tinnitus, nausea and vomiting regardless of food intake, dizziness. Often proceeds without a rise in body temperature. Positive meningeal symptoms are noted: stiff neck muscles, lower Brudzinsky symptom and Kernig's symptoms. Increased intracranial pressure is possible. Neurosyphilis in the form of acute meningitis develops most often in the first few years of syphilis, during the period of its relapse. It may be accompanied by skin rashes or be the only manifestation of recurrence of secondary syphilis.
Meningovascular neurosyphilis develops with syphilitic damage to the vessels of the brain as endarteritis. It manifests itself as an acute disturbance of the cerebral circulation in the form of ischemic or hemorrhagic stroke, a few weeks before which the patient begins to be bothered by headaches, sleep disturbances, dizziness, and personality changes appear. Perhaps the course of meningovascular neurosyphilis with impaired cerebrospinal circulation and the development of lower paraparesis, sensitivity disorders and disorders of the pelvic organs.
Syphilitic meningomyelitis proceeds with damage to the membranes and substances of the spinal cord. There is a slowly growing spastic lower paraparesis, accompanied by loss of deep sensitivity and dysfunction of the pelvic organs.
Dorsal tabes occurs as a result of syphilitic inflammatory lesions and degeneration of the posterior roots and cords of the spinal cord. This form of neurosyphilis appears on average 20 years after infection. It is characterized by radiculitis with severe pain syndrome, loss of deep reflexes and deep types of sensitivity, sensitive ataxia, neuro-trophic disorders. With neurosyphilis in the form of tabes dorsal, impotence may develop. There are neurogenic trophic ulcers on the legs and arthropathies. Argyll-Robertson syndrome is characteristic - irregularly shaped constricted pupils that do not respond to light. The above symptoms may persist after specific therapy for neurosyphilis.
Progressive paralysis may appear in patients with a 10-20-year-old disease. This variant of neurosyphilis is associated with the direct penetration of pale treponemes into the brain cells with their subsequent destruction. It is manifested by gradually increasing personality changes, memory impairment, impaired thinking up to the onset of dementia. Often there are mental abnormalities such as depressive or manic states, hallucinatory syndrome, delusional ideas. Neurosyphilis in the form of progressive paralysis can be accompanied by epileptic seizures, dysarthria, pelvic dysfunction, intentional tremor, and decreased muscle strength and tone. Perhaps a combination with manifestations of dorsal dryness. Typically, patients with similar symptoms of neurosyphilis die within several years.
Syphilitic gum localized most often at the base of the brain, which leads to compression of the roots of the cranial nerves with the development of paresis of the oculomotor nerves, atrophy of the optic nerves, hearing loss, etc. As the gum grows in size, intracranial pressure increases and signs of compression of the brain matter increase. Less commonly, gum in neurosyphilis is located in the spinal cord, leading to the development of lower paraparesis and dysfunction of the pelvic organs.
Diagnosis of neurosyphilis
The diagnosis of neurosyphilis is made taking into account 3 main criteria: the clinical picture, positive test results for syphilis, and identified changes in the cerebrospinal fluid. A correct assessment of the clinic of neurosyphilis is possible only after a neurologist has performed a complete neurological examination of the patient. Important additional information for the diagnosis of neurosyphilis is provided by a visual examination and an examination of the fundus, which is carried out by an ophthalmologist.
Laboratory tests for syphilis are used in a comprehensive manner and, if necessary, repeatedly. These include RPR-test, RIF, RIBT, detection of pale treponema with the contents of skin elements (if any). In the absence of symptoms of brain compression, a patient with neurosyphilis undergoes a lumbar puncture. The study of cerebrospinal fluid in neurosyphilis reveals pale treponemas, increased protein content, inflammatory cytosis over 20 μl. RIF with cerebrospinal fluid, as a rule, gives a positive result.
MRI of the brain and CT of the brain (or spinal cord) with neurosyphilis reveal mainly nonspecific pathological changes in the form of thickening of the meninges, hydrocephalus, atrophy of the brain substance, heart attacks. With their help, it is possible to identify the localization of gum and to differentiate neurosyphilis from other, similar clinically, diseases.
The differential diagnosis of neurosyphilis is carried out with meningitis of another genesis, vasculitis, brucellosis, sarcoidosis, borreliosis, tumors of the brain and spinal cord, etc.
Treatment of neurosyphilis
Therapy of neurosyphilis is carried out in stationary conditions by intravenous administration of large doses of penicillin preparations for 2 weeks. Intramuscular penicillin therapy does not provide a sufficient concentration of antibiotic in the cerebrospinal fluid. Therefore, if intravenous therapy is impossible, intramuscular administration of penicillins is combined with probenicid, which inhibits the excretion of penicillin by the kidneys. Ceftriaxone is used in patients with neurosyphilis who are allergic to penicillin.
On the first day of neurosyphilis treatment, a temporary aggravation of neurological symptoms may occur, accompanied by a rise in body temperature, intense headache, tachycardia, arterial hypotension, arthralgia. In such cases, penicillin therapy of neurosyphilis is supplemented by the appointment of anti-inflammatory and corticosteroid drugs.
The effectiveness of treatment is assessed by the regression of the symptoms of neurosyphilis and the improvement in cerebrospinal fluid parameters. Monitoring the cure of patients with neurosyphilis is carried out for 2 years by examining the cerebrospinal fluid every six months. The appearance of new neurological symptoms or the growth of old ones, as well as persistent cytosis in the cerebrospinal fluid are indications for a repeated course of treatment for neurosyphilis.
Neurosyphilis is a venereal disease that disrupts the work of some internal organs, and if untreated, it spreads to the nervous system in a short time. It can occur at any stage of the course. The development of the disease is accompanied by attacks of the strong, muscle weakness,. Dementia and paralysis of the limbs are common.
Infection occurs through sexual contact, after which the infection spreads throughout the body with a stream of blood. With the development of the pathological process, the number of antibodies decreases, after which the virus infects the nervous system.
The disease can be either acquired or congenital.
Etiology of the disease
The main factor in the onset of the disease is the bacterium pale treponema. This means that the infection comes from an infected person.
The main routes of infection are:
Factors predisposing to the progression of the disease:
- untimely treatment of syphilis;
- mental strain;
- frequent stress or strong emotional outburst;
- brain injury;
- weakened;
- at risk are medical workers who are constantly in contact with various biological secretions of a person: blood, saliva or sperm. Infection can occur during surgery or labor.
The most infectious are patients who carry the disease in the early stages. People with a disease duration of five or more years are less likely to be affected.
Forms of neurosyphilis
In medicine, neurosyphilis is divided depending on the duration of the infection. So they distinguish:
The disease is characterized depending on the severity of symptoms and several forms are distinguished:
- latent- is often diagnosed by chance during a routine examination. Symptoms of the disease are not observed, and the virus is detected by examining the cerebrospinal fluid;
- syphilitic meningitis- mainly observed in young people. The main symptoms: a, weakness, decreased visual acuity;
- dorsal tabes- damage to the cords and roots of the spinal cord occurs;
- meningovascular neurosyphilis- blood circulation in the brain is disturbed. Observed and sleep problems;
- gummy neurosyphils- characterized by progressive paralysis. This form occurs with late neurosyphilis.
If diagnostics and treatment are not carried out in time, the disease can lead to disability, complete paralysis and death.
Symptoms of neurosyphilis
For each form of the disease, there are specific signs.
Early neurosyphilis symptoms:
- attacks and;
- decreased sensitivity of the pelvic organs;
- strong and
- decreased visual acuity and hearing;
- against the background of nocturnal cramps, sleep disturbances occur;
- and concentration;
- muscle weakness.
Symptoms of late neurosyphilis:
- complete loss of vision in the beginning of one eye, and then, as the progression of blindness becomes bilateral;
- hallucinations;
- increased irritability;
- inappropriate behavior;
- change in gait and handwriting;
- tremor of the tongue;
- increased body temperature.
Gradually, the disease leads to paralysis, seizures and disruption of the pelvic organs.
Symptoms of congenital neurosyphilis:
With timely diagnosis and proper therapy of the congenital form, the progression of the infection can be stopped, but the consequences of a violation of the nervous system will remain for life.
Diagnosis of the disease
Neurosyphilis is diagnosed on the basis of the clinical picture, laboratory study of cerebrospinal fluid and a positive test result. Also important are neurological examination, laboratory blood tests (RIBT and RIF) and examination of the patient by an ophthalmologist. In some cases, blood tests are done more than once.
With the latent stage of neurosyphilis, a study of the cerebrospinal fluid is carried out. 
Examinations of either the spinal cord or the brain can detect pathological changes in the membranes of these organs, as well as the site of infection. An important part of the diagnosis is the differentiation of neurosyphilis from other diseases with similar symptoms. These include: malignant and spinal cord diseases, sarcoidosis, of various nature.
Treatment of neurosyphilis
Disease therapy is carried out only in a hospital. Special drugs with a high content of penicillin are injected into the patient's body.
The duration of the course of treatment is at least two weeks. For greater digestibility, the administration of probenicid is additionally prescribed - a substance that inhibits the excretion of penicillin by the kidneys. Patients who are allergic to this drug are prescribed ceftriaxone. On the first day of therapy with this medicine, the body temperature rises, the heart rate increases, and unbearable headaches occur.
In addition to penicillin, corticosteroids and anti-inflammatory drugs are prescribed.
The degree of expression of the symptoms of the disease and the improvement in the state of the cerebrospinal fluid are the criteria by which the effectiveness of therapy is assessed. At the end of the treatment, the patient's condition is monitored for two years. For this, a study of cerebrospinal fluid is carried out every six months. If new symptoms arise, or the old ones worsen, a second course of drug therapy is prescribed.
At an early stage, the disease can be almost completely eradicated. With severe damage to the nerves and blood vessels, some signs may remain with the patient for life. The congenital form leads to lifelong deafness and sometimes disability.
To exclude the possibility of infection, it is enough to carefully follow the procedures of personal hygiene, to exclude unprotected sex, and also not to use common things and devices with an infected person.
Neurosyphilis is a group of diseases of the nervous system caused by treponema pallidum.
The prevalence of syphilitic lesions of the nervous system is up to 264.6 per 100 thousand population. Rural residents and females are more likely to get sick.
Classification
1. Early neurosyphilis. Less than 5 years elapsed between infection and neurological manifestations. The membranes and vessels of the brain suffer (mesenchymal neurosyphilis).
• Early asymptomatic syphilitic meningitis;
Acute syphilitic meningitis;
• Chronic syphilitic meningitis;
Early meningovascular syphilis;
Syphilitic meningomyelitis;
Syphilitic hypertrophic cervical pachymeningitis;
Neuritis of the optic and auditory nerves.
2. Late neurosyphilis. More than 5 years have passed between infection and the onset of clinical manifestations. The parenchyma of the brain (parenchymal neurosyphilis) suffers.
Late diffuse meningovascular syphilis;
Syphilis of cerebral vessels (vascular syphilis);
Late pupillary monosyndrome;
Pretabes;
Tabes of the spinal cord;
Progressive paralysis;
Brain gum.
Currently, syphilis is acquiring an erased clinical coloration, an atypical and oligosymptomatic course. This is due to the so-called pathomorphosis of the disease, i.e. a change in the course of the disease under the influence of a number of factors.
Such a clinical course may be associated with a change in ecology, a deterioration in socio-economic conditions, a combination with TBI, exposure to stress factors, an increase in alcoholism, an increase in solar activity, a decrease in immunity, and uncontrolled use of antibiotics.
Early neurosyphilis
Most common latent asymptomatic meningitis... It proceeds with headache, tinnitus, dizziness, soreness when moving the eyeballs. The characteristic meningeal symptoms, however, are not observed. There are symptoms of intoxication - malaise, weakness, insomnia, irritability, depression. During lumbar puncture, typical signs of meningitis are found in the cerebrospinal fluid - pleocytosis, protein, increased cerebrospinal fluid pressure.
Acute generalized syphilitic meningitis is a rarer form. It proceeds with high fever, intense headache, dizziness, vomiting, severe meningeal symptoms. There may be epileptic seizures, pathological reflexes, i.e. the process also involves the substance of the brain.
With development basal syphilitic meningitis cranial nerves are involved in the pathological process. Most often these are the III, V, VI, VIII nerves. Ptosis, squint, and facial asymmetry appear. Damage to the auditory nerves is manifested by a decrease in bone conduction. The optic nerves are often involved. This is manifested by a decrease in visual acuity up to blindness, concentric narrowing of the visual fields.
Early meningovascular syphilis is a rare clinical form. It is characterized by moderately expressed cerebral symptoms, shell symptoms. Focal symptoms are manifested in the form of aphasias, seizures, hemiparesis, sensory disturbances and alternating syndromes.
Syphilitic meningomyelitis is characterized by an acute onset, the rapid development of paraplegia of the lower extremities with pelvic disorders and sensory disorders of the conductive type.
When the spinal roots are involved in the process, meningoradiculitis with severe pain syndrome occurs.
Other manifestations of early neurosyphilis include the following:
• Anisocoria and unilateral deformity of the pupil.
• Lethargy of pupillary reactions.
Argyll-Robertson syndrome.
• Weak convergence.
Horizontal nystagmus.
Central paresis of the VII pair.
• Paresis of the XII pair.
Anisoreflexia.
• Violation of sensitivity.
Syndrome of vegetative dystonia.
The involvement of the hypothalamus in the process can cause a change in the cycle of menstruation, acrohypothermia, sympathoadrenal crises, migraine headaches, thirst, hunger, lack of appetite, cachexia, sleep disturbance, and joint damage.
Diagnosis of early forms is carried out on the basis of cerebrospinal fluid analysis: protein increases from 0.5 to 1 g / l, lymphocytic pleocytosis (50-100 in 1 μl), paralytic type of Lange colloidal reaction. RW is 90-100% positive. In addition, changes in the EEG and USG data are found.
Treatment of early forms is carried out with penicillin. Antibiotic therapy prevents the development of late forms of neurosyphilis.
Late neurosyphilis
The clinic of late neurosyphilis appears 7-8 years after infection.
Pathomorphology. The changes are of an inflammatory-dystrophic nature. Nerve cells, glia, pathways are affected. The inner wall of blood vessels suffers with symptoms of intimal necrosis, proliferation of connective tissue and blockage of blood vessels. In the brain tissue, foci of softening, infiltrates are found. Gummy nodes are formed initially from the membranes, and then grow into the substance of the brain. Over time, gumma begins to disintegrate in the center.
Clinic
Late syphilitic meningitis. It begins gradually, there is no temperature reaction characteristic of meningitis. The course of meningitis is chronic and recurrent. General cerebral symptoms are manifested by headache, vomiting. Meningeal symptoms are mild. Syphilitic meningitis is most often basal, so the characteristic sign is the involvement of the cranial nerves in the process. Most often, the third couple suffers. You can identify Argyll-Robertson syndrome (lack of pupil response to light while maintaining convergence and accommodation). In addition, there may be miosis, anisocoria. The defeat of the second pair is manifested by a decrease in visual acuity, hemianopsia. On the fundus there may be atrophy, stagnant discs. In the cerebrospinal fluid, an increase in protein up to 0.5-1 g / l and pleocytosis of 20-70 cells can be detected.
Vascular syphilis and late meningovascular syphilis. They occur with damage to one or more cerebral vessels. The disease proceeds according to the type of acute cerebrovascular accident. Focal symptoms are manifested in the form of hemiparesis, hemiplegia, sensitivity disorders, aphasias, memory disorders, alternating syndromes.
Late pupillary monosyndrome proceeds with the phenomena of anisocoria, ptosis, Argyll-Robertson syndrome.
In the diagnosis of late forms of neurosyphilis, serological reactions are of particular importance. RW positive at 40%, RIF at 70%, RIBT is a highly sensitive method.
Dorsal tabes or Tabes dorsales is a manifestation of the most late syphilis of the nervous system (the so-called quaternary syphilis). The disease develops 25 years after the acute period.
Pathomorphology. The greatest changes are found in the spinal cord in the dorsal columns and dorsal roots at the thoracic and lumbar levels. The greatest changes are observed in the Gaulle and Burdach beams. In addition, changes are found in the pia mater along the posterior surface of the spinal cord. The picture corresponds to chronic hyperplastic leptomeningitis. Changes are found in some cranial nerves, spinal nerves, autonomic ganglia and plexuses.
Clinic. The most common clinical picture is pain, paresthesia, hyperesthesia associated with irritation of the dorsal roots.
The pains are shooting or lancinating. Localized most often in the lower extremities, last 1-2 seconds. Pain attacks begin suddenly. Patients say that there is a sensation of a piercing electric current. Sometimes pain attacks last several hours.
Paresthesias are felt in the form of a tightening of the abdomen with a belt, a tingling sensation, a burning sensation in the limbs. In the later stages, the patient experiences a sensation of a layer under the feet, walking as if on felt.
Hypesthesia occurs on painful and tactile stimuli most often at the level of the nipples, along the medial surface of the forearm and the lateral surface of the lower leg. Hyperesthesia to cold is observed on the lateral surfaces of the body. As a manifestation of hypesthesia, the following symptoms can be considered: Abadi - painlessness of compression of the Achilles tendon) and Bernatsky (insensitivity of the ulnar nerve when it is compressed).
One of the main symptoms of tabes is tabetic crises. These are attacks of pain in a particular organ with a temporary dysfunction of this organ. Pain can be in the stomach, mimicking a peptic ulcer. Are accompanied by vomiting. Pain can be in the intestines, accompanied by diarrhea and colic. Cardiac crises resemble attacks of angina pectoris. Renal crises mimic the ICD.
The defeat of the posterior columns of the spinal cord leads to a violation of the vibrational and musculo-articular sense and the development of sensitive ataxia. The gait becomes uncertain, awkward. It is called a rooster because the patient raises his legs high and puts them on the heel from full swing. It becomes difficult to descend the stairs.
Knee and Achilles reflexes decrease most early and then are lost. And the knees are the first to disappear. Skin reflexes remain intact throughout the disease.
In the muscles of the lower extremities, hypotension occurs and, as a result, hyperextension in the joints.
Pelvic disorders are common. At first there is a delay in urination, then incontinence develops. Sexual function suffers.
In addition, with tabes, the development of pupillary disorders is possible, the visual, auditory and abducens nerves are affected.
Among trophic disorders, painless arthropathies, perforating foot ulcers, loss of hair and teeth, thinning of the skin are described.
In the diagnosis of tabes, the analysis of cerebrospinal fluid is important: the liquid is colorless, transparent, the pressure can be increased, the protein is slightly increased, pleocytosis reaches 20-30 cells in 1 μl.
In its course, the tabes of the spinal cord is a long-term, chronic disease. It can take 20-30 years. The following stages are distinguished: Neuralgic. It is characterized by pain phenomena, pupillary disorders and mild pelvic disorders. The second stage is atactic. Deep sensitivity suffers and ataxia develops. The third stage is paralytic. The patient is immobilized due to severe ataxia, pelvic disorders are expressed.
Diagnosis of tabes is based on clinical manifestations, tabetic crises are important in the diagnosis. In the cerebrospinal fluid, a slight increase in the amount of protein is found, lymphocytic pleocytosis up to 20-30 cells in 1 μl. There may be a positive Wasserman reaction, RIBT, RIF, the Lange curve is paralytic.
Progressive paralysis
It also develops 10-20 years after infection. The core of the clinic is made up of personality changes: memory, counting, writing are impaired, acquired skills are lost, abstract thinking. The neurological status includes Argyll-Robertson syndrome, paresis of the extremities, impaired sensitivity, and epileptic seizures. At present, the classical forms - manic and expansive - practically do not occur, but there are demential forms with dementia, frustration of criticism, apathy, complacency. In some cases, the symptoms of tabes dorsalis are combined with an increase in dementia, personality degradation, and hallucinatory syndrome. In such cases, we are talking about tobacco paralysis.
In the differential diagnosis of progressive paralysis, manic-depressive psychosis, tumors of the frontal lobe, studies of cerebrospinal fluid are important (an increase in the protein content to 0.45-0.6 g / l, a positive Wasserman reaction, paralytic type of the Lange curve).
Gum of the brain and spinal cord
It is now extremely rare. Its favorite localization is the base of the brain; less often gum is located in the medulla. The clinical course resembles a brain tumor, with which a differential diagnosis should be made. Gumma leads to an increase in intracranial pressure. Focal symptoms depend on its location. The symptom complex of the spinal cord gum is expressed by the clinic of an extramedullary tumor.
In the differential diagnosis, a positive Wassermann reaction, a paralytic type of the Lange curve, positive RIBT and RIF are of decisive importance.
Treatment of neurosyphilis. Carry out with preparations of iodine and bismuth. During the first 2-4 weeks, potassium iodide is prescribed (3% solution, 1 tablespoon 3-4 times a day; 2-5 g per day). After that, treatment with bismuth is carried out: biyoquinol or bismoverol (2 ml intramuscularly every other day; for a course of 20-30 ml biyoquinol or 16-20 ml bismoverol). This treatment should be carried out under the supervision of urine tests for the timely detection of bismuth nephropathy. Penicillin therapy begins with a dose of 200,000 IU every 3 hours. The patient should receive 40,000,000 IU of penicillin, after which treatment with bioquinol is again carried out to a total dose of 40-50 ml. After a break of 1-2 months, a second course of penicillin therapy is prescribed, followed by the use of bismuth preparations. After a repeated 2-3-month break, another 1-2 courses of treatment with salts of heavy metals are carried out. The criterion for the effectiveness of anti-syphilitic treatment is the data of clinical and cerebrospinal fluid examination. Before and throughout the specific treatment, multivitamins, vitamin B12 in large doses, biogenic stimulants (aloe, vitreous), ATP, vascular drugs (nicotinic acid), drugs that improve neuromuscular conductivity (proserin) are recommended. For tabet pain, drugs should not be prescribed, as drug addiction is likely to develop. Preference is given to carbamazepine (tegretol). Treatment is supplemented with non-specific agents that have a pyrogenic effect (pyrogenal). After a course of specific treatment, patients can be sent to resorts with sulfuric and radon sources. For the treatment of ataxia, special sets of exercises have been developed (according to Frenkel), in which the patient is taught the skills to replace the lack of control over movements with vision.
Syphilis is understood as a disease of a venereal nature, which disrupts the work of some systems of internal organs. In the absence of competent treatment, after a short period of time, neurosyphilis may develop, characterized by the penetration of infection into the nervous system. This is a very dangerous pathology for human health, threatening complete disability or death.
What is neurosyphilis?
Neurosyphilis refers to an infectious disease of the human central nervous system. The development of pathology is due to the penetration of the causative agent of syphilis into the body. Infection can involve all parts of the nervous system in the pathological process, from the brain to the sense organs. Clinically, the disease is manifested by a number of neurological disorders: dizziness, muscle weakness, paralysis, convulsions, dementia.
For the first time they started talking about syphilis in the Middle Ages. In those days, alchemists did not yet know what neurosyphilis was. Participants of the Crusades suffered from the disease. During the Hundred Years War, syphilis was otherwise called a French disease, since the British "brought" it from the mainland. Several decades ago, syphilis was considered a death sentence for an infected person. Thanks to the rapid development of science, this ailment can now be cured in a few weeks. However, neglected forms often cause death. The high mortality rate for neurosyphilis is especially relevant.
The disease can manifest itself at any time during the development of a syphilitic infection. Diagnosis is based on the results of serological research methods and clinical manifestations. Narrow-spectrum antibiotics are usually used for treatment. Today, neurosyphilis disease is much less common than in the last century. This is due to the improvement in the quality of diagnostic measures, preventive examinations of the population, and early therapy.
The main causes of infection
The causative agent of neurosyphilis is the bacterium pale treponema. Infection occurs directly from a sick person. This usually happens with unprotected intercourse. The pathogenic microorganism enters the human body through damage to the mucous membranes or skin. The infection then spreads along with the bloodstream.
The body reacts to foreign bacteria by producing antibodies. With a decrease in the blood-brain barrier, pale treponema is introduced into the nervous system. Thus, neurosyphilis gradually develops.
The causes of this pathology can also be non-specific. The development of the disease is facilitated by untimely treatment of early forms of the disease, emotional experiences, decreased immunity, craniocerebral trauma, mental fatigue.
The main routes of infection:
- Sexual... This is the most common transmission of infection. The pathogen penetrates through mucous membranes and microdamages on the skin. The type of sexual intercourse usually does not play a special role. The use of barrier contraceptives (condoms) reduces the risk of infection, but does not eliminate it.
- Blood transfusion(for blood transfusion, dental procedures).
- Domestic... Domestic infection requires very close contact with a sick person. Transfer through towels, common household items, the use of a single razor or brush is not excluded.
- Transplacental(transmission from mother directly to fetus).
- Professional... First of all, this applies to medical workers who have constant contact with biological fluids (blood, semen, saliva). Infection is possible during obstetrics, surgery, and autopsy.
Any contact with a person infected with neurosyphilis always carries a threat.
Clinical picture
Signs of neurosyphilis can be pronounced or erased when the disease is at an early stage of development. Among the general symptoms characteristic of the disease, doctors include periodic headaches, fatigue, numbness of the limbs.
Experts distinguish between early, late and congenital variants of the disease. The first develops within several years from the moment of infection. Otherwise, it is called mesenchymal, since, first of all, the vessels and membranes of the brain are involved in the pathological process. The late form of pathology manifests itself approximately five years after the penetration of pale treponema into the body. It is accompanied by damage to nerve cells and fibers. Congenital neurosyphilis develops as a result of transplacental transmission of infection from mother to fetus and manifests itself during the first months of a child's life.
Early neurosyphilis
This form of the disease usually develops within 2-5 years after the infection enters the body. This condition is accompanied by damage to the membranes and blood vessels of the brain. Its main manifestations include syphilitic meningitis, meningovascular syphilis, and latent neurosyphilis. The symptoms and characteristic signs of each form will be considered in more detail below.
Late neurosyphilis
This pathology is also divided into several forms:
- Progressive paralysis.
- Dorsal tabes.
- Gummy neurosyphilis.
- Optic nerve atrophy.
- Meningovascular neurosyphilis (symptoms are similar to the early form of this disease).
When it comes to progressive paralysis imply chronic meningoencephalitis. It usually develops 5-15 years after infection with syphilis. The main reason for this form of the disease is the penetration of pale treponemas into the brain cells, followed by their destruction. Initially, the patients show changes in higher nervous activity (impairment of attention and memory, irritability). As the disease progresses, mental disorders (depression, delusional ideas and hallucinations) join. Symptoms of a neurological nature include tremor of the tongue, dysarthria and changes in handwriting. The disease develops rapidly and is fatal within several months.
With the defeat of the posterior roots and cords of the spinal cord, doctors talk about dorsal tabes. Clinically, the pathology manifests itself in the form of loss of Achilles reflexes, instability in As a result, a person's gait changes. The occurrence of optic nerve atrophy is not excluded. Trophic ulcers are another characteristic feature of the disease.
In some cases, atrophy is an independent form of an ailment such as neurosyphilis. The consequences of the disease significantly reduce the quality of human life. The initial pathological process affects only one eye, but after a while it becomes bilateral. Decreased visual acuity. In the absence of timely treatment, complete blindness develops.
Gummy neurosyphilis. Gummas are rounded formations that form as a result of inflammation caused by treponema. They affect the brain and spinal cord by compressing the nerves. Clinically, the pathology is manifested by paralysis of the limbs and pelvic disorders.
Congenital neurosyphilis
This form of pathology is rarely diagnosed. During pregnancy, the expectant mother is repeatedly examined for infections. If intrauterine infection has occurred, it is very easy to recognize it. The clinical picture is characterized by the same symptoms as in adult patients, with the exception of tabes dorsal.
The congenital form of the disease has its own distinctive symptoms. This is hydrocephalus and the so-called Hutchinson's triad: deafness, keratitis and deformation of the upper incisors. Timely treatment can stop the infectious process, but neurological symptoms persist throughout life.
Diagnosis of neurosyphilis
We have already described what neurosyphilis is. How can this disease be confirmed? The final diagnosis is possible taking into account three main criteria: a characteristic clinical picture, test results for syphilis, identification of changes in the composition of the cerebrospinal fluid. An adequate assessment of the patient's condition is permissible only after a neurological examination.
As for laboratory research, they are carried out in an integrated manner. In some cases, multiple repetitions of tests are required. The most informative methods of laboratory diagnostics include RPR-analysis, RIBT, RIF, as well as identification of the causative agent of infection in the contents of the affected skin areas.
In the absence of pronounced symptoms, it is carried out. With neurosyphilis, an increased level of protein and the causative agent of the disease, pale treponema, is found in the cerebrospinal fluid.
MRI and CT of the spinal cord are prescribed for all patients with suspected neurosyphilis. Diagnostics using special devices allows you to identify hydrocephalus and atrophy of the medulla.
How to beat neurosyphilis?
Treatment of early forms of the disease is based on aggressive antibiotic therapy. For this, drugs of the penicillin and cephalosporin series are used. As a rule, therapy is complex and involves the use of several medicines at the same time. The usual scheme: "Penicillin", "Probenecid", "Ceftriaxone". All drugs are administered intravenously. Penicillin is also injected into the spinal canal. The course of treatment usually lasts two weeks. After this, the patient undergoes a second examination, according to the results of which it is possible to judge whether it was possible to defeat neurosyphilis. Treatment is prolonged if pale treponema is found in the cerebrospinal fluid.
On the first day of drug therapy, neurological symptoms (headache, fever, tachycardia) may increase. In such cases, treatment is supplemented with anti-inflammatory and corticosteroid medications.
To combat the late form of neurosyphilis, drugs with arsenic and bismuth are used, which are highly toxic.
Forecast and consequences
Early forms of neurosyphilis respond well to therapy, and full recovery is possible. In some cases, the so-called residual effects and paresis persist, which can cause disability.
Late forms of pathology do not respond well to drug therapy. Symptoms of a neurological nature, as a rule, remain with the patient for life.
Progressive paralysis was fatal until a few years ago. Today, the use of penicillin antibiotics can alleviate the manifestation of symptoms and slow down neurosyphilis.
Photos of patients with such a diagnosis and after a course of treatment make it possible to understand what kind of threat the pathology poses to the body. That is why everyone should know how to prevent this ailment.
Prevention measures
To prevent infection, doctors recommend abandoning uncontrolled sexual intercourse. Personal hygiene should be given special attention. People infected with treponema pallidum must undergo preventive examinations by a neurologist without fail.
What is neurosyphilis? This is a dangerous disease characterized by damage to the central nervous system. In the absence of timely treatment, there is a high probability of developing life-threatening complications that directly affect the quality of life, and sometimes lead to death. Therefore, one should not neglect the prevention of the disease, and after infection, immediately seek help from a doctor.
Neurosyphilis is an infectious disease of the central nervous system caused by the reproduction of the pathogen in the human body - treponema pallidum. It is also commonly known as brain syphilis.
Treponema pallidum enters the body due to the predominantly genital tract and affects the mucous membranes of organs. It is also possible to get infected by household, through shared linen, dishes, towels. The pathogen moves through the body along the bloodstream and lymphatic channels. Syphilis of the brain is possible due to the increased permeability of the blood-brain barrier. can occur in any period.
Therefore, there is one simple answer to the question of what neurosyphilis is. Just like in other organs and tissues of the body, treponema pale begins to multiply rapidly, affecting the brain cells. The disease is characterized by the formation of syphilitic gum in the structure of the brain. Neuro syphilis can also have symptoms of meningitis, meningomyelitis, spinal cord injury, and paralysis.
How neurosyphilis is transmitted
There are 2 main ways in which neurosyphilis is infected:
- sexual - with tactile contact with an open focus of infection (syphilitic gum or hard chancre);
- household contact - when using common dishes, linen, towels.
Also, the answer to the question of how neurosyphilis is transmitted is the fact that the risk of infection with treponema pallidum is also with blood transfusion. Today it is minimal, since all blood products and donors undergo compulsory testing for syphilis.
In addition, the disease can be transmitted to the baby in utero or during childbirth. Cracks and trauma to the skin and mucous membranes are the entrance gate of infection. In this case, the pathogen enters the lymph nodes, and then spreads in the body with the bloodstream.
Symptoms and Signs
Depending on the stage, the symptoms of neurosyphilis change. In acute syphilitic meningitis, vomiting, severe headaches, nausea, tinnitus, and dizziness are observed. Rashes appear on the skin, intracranial pressure rises.
Meningovascular syphilis is manifested by headaches, dizziness, poor sleep, personality changes, and its apogee is stroke. Asymptomatic neurosyphilis can also be observed, but only in the initial stages of such diseases.
With meningomyelitis, bilateral paresis gradually develops, the pelvic organs are affected. Getting into the roots of the spinal cord, treponema causes dorsal tabes. It manifests itself in the form of radiculitis, ataxia, impotence, the appearance of trophic ulcers on the lower extremities.
When treponema enters the brain cells, progressive paralysis and the formation of syphilitic gum begins. Here the signs of neurosyphilis are as follows: the disease is accompanied by memory loss, impaired thinking processes, personality changes, hallucinations, delusional ideas. In patients, muscle tone decreases, the functioning of the pelvic organs is disrupted, intracranial pressure increases, and sensory perception is impaired.
Diagnostics
The standard diagnostics for neurosyphilis includes the following components:
- initial examination and identification of neurological symptoms of the disease;
- ophthalmological examination (identification of changes in the pupils, characterized by miosis, anisocria, changes in the shape of the pupil and the presence of pathological reflexes);
- serological studies (Wasserman reaction and others);
- laboratory study of cerebrospinal fluid (neurosyphilis is indicated by the presence of a protein greater than 0.6 g / l, a positive Wasserman and RIF reaction, lymphocytosis over 20 μl);
- MRI and CT of the brain are used to exclude other diseases, as well as to detect nonspecific changes.
Classification of neurosyphilis
The classification of neurosyphilis distinguishes late and early forms of the disease. In some patients, the symptoms are pronounced, others tolerate neurosyphilis asymptomatically, and its presence can only be determined by analysis of the cerebrospinal fluid. This examination of cerebrospinal fluid helps to diagnose most diseases associated with neurological pathologies of various origins. Thus, the classification of brain syphilis also includes latent and open forms.
Early neurosyphilis
Most often, early neurosyphilis appears during the first 2-3 years after the initial infection. It is characterized by damage to the membranes of the brain in the form of meningitis, meningomyelitis and meningovascular neurosyphilis, as well as cerebrovascular accident. Among the first symptoms of early neurosyphilis are headache, hallucinations, weakness, irritability, and dizziness.
Analysis of cerebrospinal fluid shows the presence of protein in it, cytosis with a predominance of lymphocytes, a positive Wasserman test, an increase in cerebrospinal fluid pressure.
Late
Basically, late neurosyphilis appears in patients 5-7 years after infection. In this form of the disease, nerve fibers and cells are affected. The disease proceeds in the form of dorsal tabes, syphilitic gum and progressive paralysis.
Symptoms of syphilis of the brain begin gradually, ranging from shooting pains in the lower back and legs, worsening mood, and ending with paraparesis of the limbs and personality disorders. Examination reveals muscle hypotonia, paresthesia of the lower extremities, sensitive ataxia, atrophy of the pelvic floor muscles, impaired reflexes, depression, decreased criticism of one's own condition.
Treatment
According to medical standards, the treatment of neurosyphilis is carried out in an inpatient setting. First of all, the patient is given powerful antibiotic therapy for 2 weeks. Ceftriaxone preparations ( main article "") or Penicillin is administered intravenously in this case. If there is no possibility for intravenous injections, then injections are given intramuscularly, but antibiotics are supplemented with probenicid. If on the first day after the start of treatment, the condition worsens, which happens quite often, then doctors prescribe corticosteroid and anti-inflammatory drugs.
The effectiveness of treatment is evidenced by the absence of symptoms and positive dynamics in the analysis of cerebrospinal fluid. Control over a patient who has undergone treatment for brain syphilis should last for 2 years. If neurological symptoms recur, the course of treatment is repeated.
Consequences
With early diagnosis and adequate treatment, the prognosis of recovery is favorable, and the consequences of neurosyphilis will be minimal. Typically, patients respond well to antibiotic therapy.
If the disease has reached the stage of progressive paralysis, then the process is irreversible. This form of pathology threatens, at best, with disability, and at worst, with death.
The symptomatology of the tabes dorsalis does not disappear after drug therapy. With relief of symptoms, the prognosis for life will be favorable. In addition, the consequences of brain syphilis can be manifested by hydrocephalus, neurogenic arthropathy, perforated ulcers of the duodenum and stomach.
Neurosyphilis in children
Most often, neurosyphilis in children occurs as a result of early. A symptom by which one can suspect syphilis in a child is metaphysitis of long bones. In newborns, neurosyphilis cannot be ruled out based solely on negative laboratory tests of cerebrospinal fluid. Diagnostics should be comprehensive.
Early congenital neurosyphilis manifests itself in newborns and children under 2 years of age. Treponema is transmitted to a child from a sick mother during childbirth or during pregnancy. Symptoms of the tertiary type of syphilis are characteristic. has no clinical manifestations, but laboratory tests confirm the presence of the pathogen in the child's blood.
Loading ...