Neurosyphilis
Neurosyphilis is a bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated syphilis for many years.
Causes
Neurosyphilis is caused by Treponema pallidum bacteria. Neurosyphilis usually occurs about 10 to 20 years after a person is first infected with syphilis. Not everyone who has syphilis develops this complication.
There are four different forms of neurosyphilis:
- Asymptomatic (most common form)
- General paresis
General paresis
General paresis is a problem with mental function due to damage to the brain from untreated syphilis.
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- Tabes dorsalis
Tabes dorsalis
Tabes dorsalis is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.
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Asymptomatic neurosyphilis occurs before symptomatic syphilis. Asymptomatic means there aren't any symptoms.
Symptoms
Symptoms usually affect the nervous system. Depending on the form of neurosyphilis, symptoms may include any of the following:
- Abnormal walk (gait), or unable to walk
Abnormal walk
Walking abnormalities can be caused by many different types of problems. Problems with the joints, (such as arthritis), bones (such as deformities),...
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- Problems with thinking, such as confusion or poor concentration
- Mental problems, such as depression or irritability
- Headache, seizures, or stiff neck
Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
ImageRead Article Now Book Mark Article - Loss of bladder control (incontinence)
- Tremors, or weakness
Tremors
A tremor is a type of shaking movement. A tremor is most often noticed in the hands and arms. It may affect any body part, including the head, tong...
ImageRead Article Now Book Mark Article - Visual problems, even blindness
Visual problems
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
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Exams and Tests
Your health care provider will do a physical examination and may find the following:
- Abnormal reflexes
- Muscle atrophy
Muscle atrophy
Muscle atrophy is the wasting (thinning) or loss of muscle tissue.
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- Mental changes
Blood tests can be done to detect substances produced by the bacteria that cause syphilis, this includes:
- Treponema pallidum particle agglutination assay (TPPA)
- Venereal disease research laboratory (VDRL) test
- Fluorescent treponemal antibody absorption (FTA-ABS)
- Rapid plasma reagin (RPR)
With neurosyphilis, it is important to test the spinal fluid for signs of syphilis.
Tests to look for problems with the nervous system may include:
- Cerebral angiogram
Cerebral angiogram
Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.
ImageRead Article Now Book Mark Article - Head CT scan
Head CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
ImageRead Article Now Book Mark Article - Lumbar puncture (spinal tap) and cerebrospinal fluid (CSF) analysis
Lumbar puncture
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
ImageRead Article Now Book Mark ArticleCerebrospinal fluid (CSF) analysis
Cerebrospinal fluid (CSF) analysis is a group of laboratory tests that measure chemicals in the cerebrospinal fluid. CSF is a clear fluid that surro...
ImageRead Article Now Book Mark Article - MRI scan of the brain, brainstem, or spinal cord
MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
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Treatment
Penicillin (an antibiotic) is used to treat neurosyphilis. It can be given in different ways:
- Injected into a vein several times a day for 10 to 14 days.
- By mouth 4 times a day, combined with daily muscle injections, both taken for 10 to 14 days.
You must have follow-up blood tests at 3, 6, 12, 24, and 36 months to make sure the infection is gone. You will need follow-up lumbar punctures for CSF analysis every 6 months. If you have HIV/AIDS or another medical condition, your follow-up schedule may be different.
Outlook (Prognosis)
Neurosyphilis is a life-threatening complication of syphilis. How well you do depends on how severe the neurosyphilis is before treatment. The goal of treatment is to prevent further deterioration. Many of these changes will be permanent.
Possible Complications
The symptoms can slowly worsen.
When to Contact a Medical Professional
Contact your provider if you have had syphilis in the past and now have signs of nervous system problems.
Prevention
Prompt diagnosis and treatment of the original syphilis infection can prevent neurosyphilis.
Reviewed By
Jatin M. Vyas, MD, PhD, Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
National Institute of Neurological Disorders and Stroke website. Neurosyphilis. www.ninds.nih.gov/health-information/disorders/neurosyphilis. Updated July 19, 2024. Accessed November 27, 2024.
Radolf JD, Tramont EC, Salazar JC. Syphilis (Treponema pallidum). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 237.
