Neurosyphilis manifesting with rapidly progressive dementia: report of three cases.
Neurosyphilis is rather an unusual cause of dementia characterized by a rapidly progressive course and psychiatric symptoms. Diagnosis of neurosyphilis should be suspected in the presence of a global cognitive impairment consisting in disorientation, amnesia and severe impairment of speech and judgement and psychiatric symptoms such as depression, mania and psychosis, with a subacute onset. More commonly, clinical manifestations of neurosyphilis include general PARESIS (involvement of Personality, Affect, Reflexes, Eye, Sensorium, Intellect and Speech). Upon clinical suspicion, diagnosis of neurosyphilis is confirmed by a reactive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory. Here we report three Human Immunodeficiency Virus (HIV)-negative male patients presenting with psychiatric symptoms and a rapidly evolving dementia. Although magnetic resonance imaging did not address to diagnosis, CSF examination was mandatory in neurosyphilis diagnosis. Other diagnostic tools such as neuropsychology and single-photon emission computed tomography resulted supportive in the diagnosis. We showed that a prompt antibiotic treatment might stop disease progression. Therefore, neurosyphilis should be always considered even in HIV-negative patients in the presence of unexpected psychiatric symptoms accompanied by a rapidly evolving cognitive decline.
Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy, ambra.stefani@gmail.com.
A
A
Stefani
M
M
Riello
F
F
Rossini
S
S
Mariotto
F
F
Fenzi
G
G
Gambina
G
G
Zanusso
S
S
Monaco
D000368:Aged; D001921:Brain / Q000473:pathology; D003704:Dementia / Q000175:diagnosis* / Q000209:etiology*; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications* / Q000175:diagnosis*