title: Neurosyphillis presenting with normal pressure hydrocephalus in a 76 year old man.
abstract: BACKGROUND
  Normal pressure hydrocephalus (NPH) is composed of gait abnormalities, urinary incontinence and decline in mentation. It is uncommonly induced by syphilitic infection.
  
  
  METHODS
  A 76 year-old male present with gait disturbances, urinary incontinence, declining vision and cognition, with a known diagnosis of NPH. He underwent therapeutic lumbar puncture (LP), which demonstrated leukocytosis and elevated protein. Venereal disease research laboratory testing (VDRL) was reactive in a 1:64 dilution with positive fluorescent Treponemal Antibody (FTA-Abs). The subject was treated with 14 days of Intravenous (IV) Penicillin 3 million units for 3 weeks and intramuscular benzathine PCN for 2 shots, with marked clinical improvement.
  
  
  CONCLUSIONS
  The incidence of Tabes Dorsalis is limited in the age of penicillin, especially in subjects without HIV. Subjects are diagnosed with either LP RPR or VDRL, confirmed with FTA-Abs. Common treatment is IV PCN 1.4-3 mU for 10-14 days.
authors.affiliation: Department of Internal Medicine, Division of Internal Medicine, Cooper University Hospital, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School-Camden, Camden, NJ, U.S.A.
authors.forename: Shaffer R S
authors.initials: SR
authors.lastname: Mok
authors.forename: Vivek
authors.initials: V
authors.lastname: Punjabi
authors.forename: David L
authors.initials: DL
authors.lastname: Shklar
keywords: neurosyphillis; normal pressure hydrocephalus; tabes dorsalis