• Hilmar W. PrangeEmail author


Involvement of the central nervous system (CNS) may occur at all stages of syphilis. It can be assigned to primosecondary stage, early and late latency, or tertiary stage according to the interval after infection and the symptomatology. CNS involvement in early syphilis manifests as mild meningitis, cranial nerve alterations, and vascular brainstem syndromes. Syphilitic polyradiculitis also develops during the secondary stage. “Asymptomatic neurosyphilis,” syphilitic amyotrophia, as well as pachymeningitis cervicalis hyperplastica, which are very rare at present, are primarily diagnosed in the stage of late latency. Typical CNS manifestations of tertiary syphilis are meningovascular neurosyphilis, tabes dorsalis, and general paresis. Syphilitic CNS involvement is verified by pathologic cerebrospinal fluid (CSF) findings showing the constellation of a chronic inflammatory CNS process, and by the proof of intrathecal synthesis of specific antibodies against Treponema pallidum demonstrated by an antibody index (ITpA index  ³  3). First-choice therapeutic measures are infusions of high-dose penicillin G (18–30 mio IU/day). Coinfections of syphilis and human immunodeficiency virus (HIV) are characterized by complicated courses of disease. Close-meshed control examinations and longer follow-up are necessary in such cases.


Human Immunodeficiency Virus Central Nervous System Involvement Central Nervous System Symptom Venereal Disease Research Laboratory Early Syphilis 
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© Springer Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Neurologische Universitätsklinik GöttingenGöttingenGermany

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