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Enhancing clinical awareness: retrospective analysis of neurosyphilis cases and diagnostic predictors for early recognition and treatment

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Abstract

Objective

This is a retrospective analysis of clinical data from individuals diagnosed with neurosyphilis, aiming to enhance healthcare professionals’ understanding of the disease and expedite early diagnosis and intervention.

Methods

A retrospective analysis was conducted on the clinical records of 50 patients who received a diagnosis of symptomatic neurosyphilis and were admitted to the Neurology Department during the period spanning January 2012 to December 2022.

Results

Clinical manifestations encompassed diverse phenotypes, with syphilitic meningitis accounting for 16% of cases, characterized by symptoms such as headache, blepharoptosis, paralysis, blurred vision, and tinnitus. Meningovascular syphilis presented in 36% of cases, exhibiting episodic loss of consciousness, limb numbness, and limb convulsion. Paralytic dementia manifested in 36% of cases, featuring symptoms such as memory loss, sluggish response, and slow movement. Tabes dorsalis was observed in 12% of cases, presenting with weakness, numbness, and staggering. Routine cerebrospinal fluid (CSF) analysis indicated abnormal white blood cell counts in 60% of patients, while biochemical testing revealed abnormal protein content in 52% of patients. Notably, statistically significant differences were observed between patients with interstitial and parenchymatous neurosyphilis (Z = 2.023, P = 0.044) in terms of CSF protein content. Electroencephalogram (EEG) results were abnormal in six patients, and imaging studies unveiled diverse findings in 46 patients.

Conclusion

The study highlights the importance of neurological and/or ocular symptoms in diagnosing symptomatic neurosyphilis. Individuals with hypomnesia should be closely monitored for potential neurosyphilis. Integrating clinical manifestations, laboratory tests, EEG, and imaging can reduce misdiagnosis. This comprehensive approach shows promise in improving early identification and management of neurosyphilis.

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Data availability

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Acknowledgements

We are particularly grateful to all the people who have given us help on our article.

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Authors and Affiliations

  1. Department of Dermatology, Beijing Tiantan Hospital, Capital Medical University, No. 119 of Nansihuanxilu Street, Fengtai District, Beijing, 100070, China

    Ying-Shu Gao, Qing Li & Hua Feng

  2. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, National Clinical Research Center for Neurological Diseases, Beijing, 100070, China

    Heng Zhou, Zai-Qiang Zhang, Gai-Fen Liu & Yuan Shen

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  1. Ying-Shu Gao
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  2. Qing Li
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Correspondence to Qing Li.

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Ethical approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki (as was revised in 2013). The study was approved by Ethics Committee of the Beijing Tiantan Hospital, Capital Medical University (No.KY2023). Written informed consent was obtained from all participants.

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Gao, YS., Li, Q., Zhou, H. et al. Enhancing clinical awareness: retrospective analysis of neurosyphilis cases and diagnostic predictors for early recognition and treatment. Neurol Sci 45, 2825–2833 (2024). https://doi.org/10.1007/s10072-023-07285-8

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