title: An old flame reignites: vagal neuropathy secondary to neurosyphilis.
abstract: OBJECTIVE
  This report describes neurosyphilis presenting as vocal fold paresis and velopharyngeal incompetence. This represents the first reported case of neurosyphilis presenting as a vagal neuropathy since 1963.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Review of medical records and literature search.
  
  
  RESULTS
  The patient presented with voice changes and nasopharyngeal reflux of liquids. Examination showed a left vocal fold paresis and moderate velopharyngeal incompetence. Laryngeal electromyography revealed evidence of denervation, and neurologic evaluation showed bilateral Adie's pupils and a positive CSF VDRL. A remote history of syphilis treated with one intramuscular injection was obtained. The patient was treated with 6 weeks of penicillin and regained normal vocal function with minimal residual intermittent hypernasality.
  
  
  CONCLUSIONS
  Given the recent increase in the incidence of syphilis in the United States, this case serves as a reminder of the importance of including syphilis in the differential diagnosis of cranial neuropathies and the increasing likelihood of syphilis presenting to otolaryngology and speech pathology practices. Syphilis, a disease whose incidence had declined progressively for 60 years in the United States, is now resurgent and must be considered in the evaluation of patients presenting with unexplained cranial neuropathies.
authors: Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
authors: Travis A L
authors: TA
authors: Klein
authors: Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida. Electronic address: mridley@health.usf.edu.
authors: Marion B
authors: MB
authors: Ridley
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D004576:Electromyography; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009494:Neurosyphilis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D010401:Penicillin G Benzathine / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine
keywords: Neurosyphilis; Vagal neuropathy; Velopharyngeal incompetence; Vocal fold paresis