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Neurosyphilis
Aka: Neurosyphilis, Tabes Dorsalis, Argyll-Robertson Pupil, Prostitute Pupil, Syphilitic Paresis, Dementia Paralytica- See Also
- Epidemiology
- Occurs in 10% of untreated Syphilis
- Symptoms
- Slow mental deterioration
- Headaches
- Personality change
- Signs
- Tremor of lips, Tongue or hands
- Argyll Robertson Pupil
- Seizures
- Ataxia
- Aphasia
- Hyperreflexia
- Cognitive changes
- Types
- Asymptomatic (Cerebrospinal Fluid positive VDRL)
- Meningovascular
- Begins 5 to 10 years after initial infection
- Acute or subacute Aseptic Meningitis
- Tabes Dorsalis
- Onset 20 to 30 years after initial infection
- Progressive degeneration of spinal cord
- Posterior roots
- Posterior Columns
- Charcot's Joints
- Argyll-Robertson Pupil (Prostitute Pupil)
- Accommodates but does not react
- Syphilitic Paresis (Dementia Paralytica)
- Chronic meningoencephalitis
- Evolves into Psychosis
- Labs: CSF Evaluation
- See Syphylis Testing
- Screening
- CSF VDRL (high Specificity)
- CSF white cell count >10/mm3
- CSF Protein >50 mg/dl
- Retesting if CSF VDRL negative
- Treponemal specific CSF tests (e.g. TPHA)
- High false positive rate
- Consider TPHA index (compares CSF to serum titer)
- Spirochete DNA PCR from CSF sample
- Higher Specificity than TPHA
- Not yet widely available
- Treponemal specific CSF tests (e.g. TPHA)
- Management
- See Syphilis
- Aqueous crystalline Penicillin G
- Dose: 3-4 MU IV q4 hours for 10-14 days
- Alternative: 0.75 to 1 MU/hour continuous IV
- Procaine Penicillin (only in compliant patients)
- Dose 2.4 MU IM qd for 14 days
- Use with Probenecid 500 mg qid for 14 days
- Penicillin Allergy
- Desensitize and treat with Penicillin
- Ceftriaxone 2 g IM/IV qd for 14 days
Neurosyphilis (C0027927) |
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| Definition (NCI) | Infection of the brain or spinal cord by Treponema pallidum. It occurs many years following the original infection which remained untreated. Signs and symptoms include abnormal gait, blindness, depression, paralysis, seizures and dementia. |
| Definition (MSH) | Infections of the central nervous system caused by TREPONEMA PALLIDUM which present with a variety of clinical syndromes. The initial phase of infection usually causes a mild or asymptomatic meningeal reaction. The meningovascular form may present acutely as BRAIN INFARCTION. The infection may also remain subclinical for several years. Late syndromes include general paresis; TABES DORSALIS; meningeal syphilis; syphilitic OPTIC ATROPHY; and spinal syphilis. General paresis is characterized by progressive DEMENTIA; DYSARTHRIA; TREMOR; MYOCLONUS; SEIZURES; and Argyll-Robertson pupils. (Adams et al., Principles of Neurology, 6th ed, pp722-8) |
| Concepts | Disease or Syndrome (T047) |
| MSH | D009494 |
| ICD9 | 094.9, 094 |
| ICD10 | A52.3 |
| SnomedCT | 186884004, 187356008, 186895005, 26039008, 154384001, 266210001 |
| French | NEUROSYPHILIS, Neurosyphilis, non précisée, Neurosyphilis, Syphilis nerveuse, Neuro-syphilis, Syphilis du SNC, Syphilis du système nerveux central |
| English | NEUROSYPHILIS, Neurosyphilis, NOS, Syphilis of central nervous system, NOS, Neurosyphilis NOS, Neurosyphilis, unspecified, [X]Neurosyphilis, unspecified, CNS SYPHILIS, SYPHILIS CNS, neurosyphilis (diagnosis), neurosyphilis, [X]Neurosyphilis, unspecified (disorder), Central Nervous System Syphilis, Syphilis, Central Nervous System, Syphilis, CNS, Neurosyphilis NOS (disorder), Neurosyphilis [Disease/Finding], cns syphilis, syphilis cns, Neurosyphilis (disorder), Syphilis of central nervous system, central nervous system; syphilitic, cerebrospinal; syphilitic, nervous system; syphilitic, neurosyphilitic, syphilis; central nervous system, syphilis; cerebrospinal, syphilis; nervous system, Neurosyphilis, Syphilis of central nervous system NOS |
| German | NEUROSYPHILIS, Neurosyphilis, unspezifisch, Neurosyphilis, nicht naeher bezeichnet, Neurosyphilis, Lues, Zentralnervensystem, Neuroleus, Syphilis, Zentralnervensystem |
| Italian | Neurosifilide, Neurosifilide non specificata, Neurolue |
| Dutch | neurosyfilis, niet-gespecificeerd, centraal zenuwstelsel; syfilis, cerebrospinaal; syfilis, syfilis; centraal zenuwstelsel, syfilis; cerebrospinaal, syfilis; zenuwstelsel, zenuwstelsel; syfilis, Neurosyfilis, niet gespecificeerd, neurosyfilis, Lues, neuro-, Neurolues, Neurosyfilis, Syfilis van het centrale zenuwstelsel |
| Portuguese | Neurossífilis NE, NEUROSIFILIS, Neurossífilis, Sífilis do Sistema Nervoso Central |
| Spanish | Neurosífilis no especificada, Neurosyphilis, Paresis Juvenil, [X]neurosífilis, no especificada, [X]neurosífilis, no especificada (trastorno), neurosífilis (trastorno), neurosífilis, SAI (trastorno), neurosífilis, SAI, neurosífilis, sífilis del SNC, sífilis del sistema nervioso central, Neurosifilis, Neurosífilis, Sífilis del Sistema Nervioso Central, Sifilis del Sistema Nervioso Central |
| Japanese | 神経梅毒、詳細不明, ｼﾝｹｲﾊﾞｲﾄﾞｸｼｮｳｻｲﾌﾒｲ, ｼﾝｹｲﾊﾞｲﾄﾞｸ, 麻痺性神経梅毒, 痴呆-麻痺性, 進行麻痺, 麻痺-進行, 麻痺性痴呆, 進行性麻痺, 神経梅毒, 梅毒-神経 |
| Swedish | Neurosyfilis |
| Czech | neurosyfilis, Neurosyfilis, blíže neurčená, Neurosyfilis |
| Finnish | Neurosyfilis |
| Russian | NEIROSIFILIS, PARALICH PROGRESSIVNYI, PROGRESSIVNYI PARALICH, НЕЙРОСИФИЛИС, ПАРАЛИЧ ПРОГРЕССИВНЫЙ, ПРОГРЕССИВНЫЙ ПАРАЛИЧ |
| Korean | 상세불명의 신경매독 |
| Croatian | NEUROLUES |
| Polish | Kiła układu nerwowego |
| Hungarian | neurosyphilis, neurosyphilis, nem meghatározott |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Tabes Dorsalis (C0039223) |
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| Definition (NCI) | A form of neurosyphilis characterized by slowly progressive degeneration of the spinal cord. Signs and symptoms include pain, ataxia, loss of coordination, personality changes, blindness, urinary incontinence, dementia, and degeneration of the joints. |
| Definition (MSH) | Parenchymatous NEUROSYPHILIS marked by slowly progressive degeneration of the posterior columns, posterior roots, and ganglia of the spinal cord. The condition tends to present 15 to 20 years after the initial infection and is characterized by lightening-like pains in the lower extremities, URINARY INCONTINENCE; ATAXIA; severely impaired position and vibratory sense, abnormal gait (see GAIT DISORDERS, NEUROLOGIC), OPTIC ATROPHY; Argyll-Robertson pupils, hypotonia, hyperreflexia, and trophic joint degeneration (Charcot's Joint; see ARTHROPATHY, NEUROGENIC). (From Adams et al., Principles of Neurology, 6th ed, p726) |
| Concepts | Disease or Syndrome (T047) |
| MSH | D013606 |
| ICD9 | 094.0 |
| ICD10 | A52.11 |
| SnomedCT | 2844004, 266134000, 316841006, 51928006, 315826004, 154384001, 266210001, 186885003 |
| English | TABES DORSALIS, TABETIC NEUROSYPHILIS, Posterior spinal scler.-syph, Neurosyphilis, Tabetic, Tabetic Neurosyphilis, Spinalis, Tabes, Tabes Spinalis, Tabes Dorsalis [Disease/Finding], dorsalis tabes, dorsalis neurosyphilis tabes, duchenne disease, tabes dorsalis, duchenne's disease, disease duchenne, Duchenne's disease, Tabes dorsalis, Syphilitic posterior spinal sclerosis, Tabetic neurosyphilis, Tabes dorsalis - neurosyphilis, Tabes dorsalis (disorder), Tabetic neurosyphilis (disorder), dorsalis; tabes, tabes; dorsalis, Tabes dorsalis (disorder) [Ambiguous], Tabes Dorsalis, Duchennes Disease, Posterior spinal sclerosis |
| Dutch | tabes dorsalis, dorsalis; tabes, tabes; dorsalis, Ruggenmergsyfilis, Tabes dorsalis |
| French | Ataxie locomotrice progressive, Tabès, Neurosyphilis tabétique |
| Portuguese | Tabes dorsal, Sífilis da Medula Espinhal, Tabes Dorsal |
| Spanish | Tabes dorsal, Tabes dorsalis, Tabes dorsalis - neurosyphilis, ataxia motora, enfermedad de Duchenne (trastorno), enfermedad de Duchenne, esclerosis espinal posterior sifilítica, neurosífilis tabética (trastorno), neurosífilis tabética, neurosífilis tábica, tabes dorsal (concepto no activo), tabes dorsal (trastorno), tabes dorsal, Sifilis de la Columna Vertebral, Tabes Dorsal, Sífilis de la Columna Vertebral |
| Swedish | Syfilitisk ryggmärgsförtvining |
| Japanese | ｾｷｽﾞｲﾛｳ, 梅毒-脊髄, 脳梅毒, 脳脊髄梅毒, 脊髄梅毒, 梅毒-脳, 脊髄ろう, 脊髄癆, 脊髄後索硬化症 |
| Czech | tabes dorsalis, Tabes dorsalis, úbytě míchy |
| Finnish | Selkäydinkato |
| Italian | Atassia spinale, Tabe dorsale, Atassia locomotoria |
| Russian | SPINNAIA SUKHOTKA, DINAMICHESKAIA ATAKSIIA, MOZGA SPINNOGO SIFILIS, SPINNOGO MOZGA SIFILIS, LOKOMOTORNAIA ATAKSIIA, TABES DORSALIS, ДИНАМИЧЕСКАЯ АТАКСИЯ, ЛОКОМОТОРНАЯ АТАКСИЯ, МОЗГА СПИННОГО СИФИЛИС, СПИННАЯ СУХОТКА, СПИННОГО МОЗГА СИФИЛИС |
| Polish | Wiąd rdzenia, Kiła rdzenia kręgowego |
| Hungarian | Tabes dorsalis |
| German | Tabes dorsalis |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
General Paralysis (C0205858) |
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| Concepts | Disease or Syndrome (T047) |
| MSH | D009494 |
| ICD9 | 094.1 |
| ICD10 | A52.17 |
| SnomedCT | 51928006, 154384001, 266210001, 186886002 |
| English | General Paralyses, Paralyses, General, Paralysis, General, General Paresis, Paretic Neurosyphilis, General Pareses, Pareses, General, DEMENTIA PARALYTICA, NEUROSYPHILIS, PARETIC, Neurosyphilis, Paretic, PARALYSIS, PROGRESSIVE, PARESIS, GENERAL, PARESIS, SYPHILITIC, Paresis, General, GPI - Gen paresis of insane, General paresis - neurosyph., paretic neurosyphilis (diagnosis), neurosyphilis paresis (GPI), general paresis, paretic neurosyphilis, General Paresis of the Insane, general paralysis, general paralysis of insane, progressive paralysis, dementia paralytica, paralytica dementia, Dementia paralytica, General paresis, Paretic neurosyphilis, Progressive general paresis, GPI - General paresis of the insane, General paralysis of insane, General paresis - neurosyphilis, General paresis of the insane, General paresis - neurosyphilis (disorder), Paralytic dementia, general paresis; neurosyphilis, general; paralysis, general; paresis, neurosyphilis; general paresis, paralysis; general, paralysis; progressive, general, paralysis; progressive, paresis; general, paresis; syphilitic, progressive; paralysis, general, progressive; paralysis, syphilis; paresis, GPI-general paralysis insane, General paresis (disorder), Dementia Paralytica, Paresis (General), General Paralysis, General paralysis of the insane, General paralysis, Progressive general paralysis |
| Dutch | gegeneraliseerde parese, gegeneraliseerd; paralyse, gegeneraliseerd; parese, gegeneraliseerde parese; neurosyfilis, neurosyfilis; gegeneraliseerde parese, paralyse; gegeneraliseerd, paralyse; progressief, gegeneraliseerd, paralyse; progressief, parese; gegeneraliseerd, parese; luetisch, progressief; paralyse, gegeneraliseerd, progressief; paralyse, syfilis; parese, Generale parese, Paretische neurolues |
| French | Parésie générale, Démence paralytique, Paralysie générale, Maladie de Bayle |
| German | allgemeine Parese, Progressive Paralyse, Paralysis progressiva |
| Italian | Paralisi progressiva |
| Portuguese | Paresia geral, Neurossífilis Parética, Paresia Geral |
| Spanish | Paresia general, General paresis - neurosyphilis, GPI-general paralysis insane, General paralysis of insane, GPI - General paresis of the insane, demencia paralítica, neurosífilis parética, paresia general (trastorno), paresia general progresiva, paresia general, Neurosífilis Parética, Paresia General, Neurosifilis Paretica |
| Czech | Celková paréza |
| Hungarian | Általános paresis |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Argyll-Robertson pupil (finding) (C0234668) |
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| Concepts | Finding (T033) |
| SnomedCT | 4129001, 155204008, 267749005 |
| English | ARGYLL-ROBERTSON PUPIL, Argyll Robertson pupil, Argyll-Robertson pupil (finding), Argyll Robertson pupil (small, react to convergence only), Argyll Robertson pupil (physical finding), the pupil was small and reacted to convergence only, Argyll-Robertson pupils, Pupil Argyll Robertson, argyll pupils robertson, argyll-robertson pupil, argyll robertson pupil, Argyll-Robertson pupil, Argyll Robertson (etiology), Argyll Robertson (manifestation), phenomenon; Argyll Robertson (etiology), phenomenon; Argyll Robertson (manifestation), pupil; Argyll Robertson (etiology), pupil; Argyll Robertson (manifestation) |
| Italian | Pupille di Argyll-Robertson, Pupilla di Argyll Robertson |
| Dutch | pupil van Argyll Robertson, fenomeen; Argyll Robertson, pupil; Argyll Robertson, Argyll-Robertson pupillen |
| French | Pupille d'Argyll Robertson, Pupilles d'Argyll-Robertson |
| German | Argyll-Robertson-Pupille, Argyll-Roberton Zeichen |
| Portuguese | Pupila de Argyll Robertson, Pupilas de Argyll-Robertson |
| Spanish | Pupila de Argyll Robertson, Argyll-Robertson pupil, Argyll Robertson pupil, pupila de Argyll - Robertson (hallazgo), pupila de Argyll - Robertson, Pupilas de Argyll-Robertson |
| Japanese | アーガイルロバートソン瞳孔, ｱｰｶﾞｲﾙﾛﾊﾞｰﾄｿﾝﾄﾞｳｺｳ |
| Czech | Argyll-Robertsonovy zornice, Argyll Robertsonova zornice |
| Hungarian | Argyll Robertson pupilla, Argyll-Robertson-pupillák |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |