Neurosyphilis: forms of pathology and therapeutic tactics. What is neurosyphilis? Symptoms, forms, treatment, consequences of Rs and neurosyphilis similar symptoms

Neurosyphilis is a type of syphilis that affects the tissues of the human central nervous system. This disease is detected in every tenth case of an organic lesion of the central nervous system. Every fifth patient with syphilis suffers from syphilitic lesions of the brain and nervous system.

What are the features of syphilis of the nervous system, what are its symptoms and consequences, and most importantly - how to deal with it, we will tell in this material.

The content of the article:

How and why does neurosyphilis begin?

All early and late forms of syphilitic lesions of the central nervous system ( CNS) begin with the fact that pale treponema (the causative agent of syphilis) enters the bloodstream and spreads throughout the body. Including treponema penetrates into the tissues of the central nervous system.

Spread occurs within a few hours after infection, then the bacteria "settle" in the tissues. In the future, pale treponemas begin to multiply in the lymphatic vessels of a person, again reach through them to CNS and deliver a second blow to the already affected nervous system. This is a more dangerous scenario for their spread, which leads to severe health consequences.

Scientists still do not know exactly what determines that syphilis will first affect the human nervous system, and not other systems or organs. It is believed that risk factors can be stress, traumatic brain injury, alcoholism and other conditions that can weaken a person's nervous system before or during illness.

It is important to consider that syphilis of the nervous system is rarely the only consequence of infection with pale treponema. As a rule, neurosyphilis begins as one of the many manifestations of the general syphilitic process in the body.

Doctors allocate early and late forms of neurosyphilis.

Early forms of neurosyphilis

Early forms of syphilis of the nervous system usually occur in the first years after infection - that is, with secondary syphilis. Sometimes early neurosyphilis occurs even in the first months of the disease - simultaneously with a hard chancre (an ulcer on the skin or mucous membrane, it is the main manifestation of primary syphilis).

The cause of early neurosyphilis is inflammation in the membranes and walls of the vessels of the spinal cord and brain. This is how the body reacts to the penetration of pale treponema into these tissues.

Symptoms of early neurosyphilis may include:

• syphilitic types of meningitis,
• meningomyelitis;
• meningoradiculitis;
• meningoencephalitis;
• endoarteritis and other diseases.

But it is interesting that in the early period of neurosyphilis, only the vessels suffer, and the tissue of the brain and spinal cord itself is almost not affected.

Late forms of neurosyphilis

Late neurosyphilis affects the very substance of the spinal cord and brain. This complication usually occurs ten or more years after the onset of syphilis.

With syphilis of the brain, its first signs are often disguised as mental illness: memory, attention, speed of thinking are disturbed. Then other mental disorders begin due to syphilis - aggression, hysterical seizures, persecution mania or megalomania, hallucinations are also possible.

Mental disorders in cerebral syphilis - aggression, hysterical seizures, persecution mania and hallucinations

If the spinal cord is affected, then signs of neurosyphilis can be:

• loss of sensation in the legs and arms;
• motor and visual disturbances;
• joint problems.

Neurosyphilis in late forms can cause much more irreversible damage to the body. The most severe manifestations of late neurosyphilis are considered to be syphilitic tabes of the spinal cord and progressive paralysis.

patients with neurosyphilis suffer from dorsal tabes

What is the spinal cord

Tabes dorsalis is a process in which syphilis gradually destroys nerve cells in the spinal cord. Normally, these cells send signals from the spinal cord to different parts of the body and receive responses. Some of the received signals continue their way from the spinal cord to the brain.

Syphilis gradually robs the nerves of the ability to transmit and receive information. As a result, organs and tissues cease to inform the central nervous system about their condition and needs. And the nervous system also cannot send them the necessary commands for full-fledged work.

The first symptoms of dorsal dryness:

Urinary dysfunction occurs because the bladder does not receive commands from the brain to get rid of excess fluid and remains full.

Then the person has problems with gait and balance, and in every fourth patient, the death of the optic nerve begins.

Blood vessels with dorsal tabes also do not receive signals from the brain. Because of this, their natural ability to contract and expand is disrupted. Such a serious violation leads to a slowdown in blood flow. As a result, from insufficient blood supply in patients with dorsal tabes, trophic ulcers arise and joint problems begin.

In the last stage of the disease, the patient begins to have problems with coordination and movement. The inflammation of the joints continues, because of which they can change shape and increase. Gradually, the person stops walking, and cannot stand or sit either.

What is progressive paralysis?

Progressive paralysis is a chronic progressive form of meningoencephalitis (when the membranes of the brain and its substance become inflamed at the same time).

The disease begins if pale treponema penetrates not only into the meninges, but also into the brain tissue of the patient and begins active life there. The body responds to this invasion with inflammation and allergic processes in the membranes and the brain itself. And if at the initial stage progressive paralysis can be defeated without complications, then with a neglected form, the patient's prospects are very sad.

Reproducing in the brain, treponema deals the main blow to mental abilities and the human psyche.

At the initial stage, progressive paralysis leads to impaired memory and attention:

• the patient becomes distracted;
• forgetful and irritable;
• there are some minor behavioral quirks.

A little later, more serious deviations appear:

• nervous breakdowns;
• bouts of violent aggression;
• mental decline.

As a result, the disease inevitably leads to severe dementia, which can additionally be accompanied by other mental disorders - delusions of megalomania, obsessions, depression, or vice versa - euphoria and excessive senseless activity.

The danger of progressive paralysis lies in the fact that in the early stages - when treatment could help - its manifestations are easily confused with the usual senile decline of the mind, overwork, neurosis, or (in young people) with various mental disorders that do not arise due to syphilis.

How to recognize neurosyphilis

Often, early neurosyphilis occurs without any symptoms at all, and then it can only be detected by blood tests and cerebrospinal fluid. Interestingly, no other characteristic signs of the disease are observed.

Types of tests for neurosyphilis

The essence of the analysis of cerebrospinal fluid

The cerebrospinal fluid flows freely through the vascular system between the spinal cord and the brain. When syphilitic inflammation begins in some part of the central nervous system, the composition of the cerebrospinal fluid also changes.

Due to this property, researchers can find treponema themselves or antibodies to them in the cerebrospinal fluid. Sometimes, in asymptomatic neurosyphilis, changes in the composition of the cerebrospinal fluid may be the only signs of neurosyphilis. According to the analysis of cerebrospinal fluid, doctors can further evaluate the success of treatment.

Features of the treatment of neurosyphilis

How effective the treatment of syphilis of the brain and nervous system will be depends on the stage of the disease: as with most diseases, early treatment always helps better than late.

Also, the treatment of early and late neurosyphilis differs in schemes, because in one and in the other case the disease causes different damage, and they also need to be treated differently.

Treatment of early neurosyphilis

At this stage, the walls of blood vessels and tissue membranes are mainly damaged. CNS and they can recover quickly. Therefore, early neurosyphilis is almost always successfully treated with antibiotics.

If the help of doctors came on time, then the answer to the question “is neurosyphilis treated” is unambiguous - yes. In this case, it is very likely that the disease will not have time to cause irreversible damage to the body.

If the treatment is late, then even the early forms of syphilis of the nervous system can permanently disrupt the usual functions of the body. Sometimes even after treatment, a person may have headaches and dizziness.

If the vessels that feed the optic or auditory nerves are affected by the disease, then after recovery, problems with vision or hearing may also remain. Fortunately, these symptoms of neurosyphilis are usually mild and do not progress afterwards.

Early treatment for neurosyphilis includes an antibiotic and the hormonal drug prednisone. The most commonly used antibiotic is penicillin, known in the treatment of syphilis for many years. With intolerance to penicillin, ceftriaxone preparations are used - for example, rocephin.

The goal of the treatment of early neurosyphilis is to create in the tissues CNS a large concentration of an antibiotic that will destroy pale treponema there. Therefore, in order for the drug to work, it is prescribed in large doses and always intravenously - this is the only way to deliver the right amount of antibiotic to the membranes and vessels of the central nervous system.

Treatment of late neurosyphilis

Unlike early neurosyphilis, the fight against late syphilis of the nervous system is a complex and not always successful process. It follows other principles.

In late forms of syphilis of the nervous system, human health is no longer destroyed by the bacteria themselves, but by the mechanisms they have launched. In such cases, antibiotics no longer help completely: they only kill treponema, but are not able to stop the destructive processes caused by it.

Often, after treatment with penicillin, a person still has disorders that do not allow him to lead a normal life. For example, in the tissues of the brain and spinal cord, scars may remain in place of syphilitic gums (cones that destroy tissues around them). Nerve fibers can also be severely damaged. And although it has been proven that they can partially recover, it takes many years.

Because of these sad features, late forms of neurosyphilis are dealt with not only by venereologists, but also by psychiatrists and neurologists.

To mitigate the consequences of the disease, drugs that help improve the condition come to the fore. However, the changes are often irreversible. At best, in the treatment of late neurosyphilis, doctors manage to stop the destructive processes, but it is no longer possible to completely restore a person’s health.

The earlier treatment began, the less severe the damage to the tissues of the nervous system will be and the more likely the patient is to recover.

Is neurosyphilis contagious?

The question of how safe it is to contact a person with syphilis of the nervous system, of course, worries him and his relatives. It is important to understand here that the level of contagiousness depends on the stage of the disease: different stages of damage to the nervous system occur at different times of general syphilis in humans.

• Early neurosyphilis

Patients are likely to be contagious: Treponema pallidum is found in their blood and other bodily fluids (saliva, semen, breast milk, etc.). Therefore, if these fluids get on injured skin or mucous membranes of a healthy person, the risk of infection will be very high.

• Late neurosyphilis

In late forms of neurosyphilis, treponemas are already deep in the tissues - they are no longer in human physiological fluids (or they are there in very small quantities). Therefore, there is practically no risk of infection. In addition, the general serious condition of patients in this period limits their ability to move and the circle of contacts.

• Treated neurosyphilis

Is treated neurosyphilis contagious? If a person is effectively treated for neurosyphilis with a full course of antibiotics, then they become completely non-infectious because these drugs kill treponema pallidum. To track exactly when the nervous system is completely cleared of bacteria, you can use the analysis of cerebrospinal fluid. Blood tests will tell about the cleansing of the body as a whole.

Syphilis of the spinal cord and brain is one of the most unpleasant complications of a common syphilitic infection. The consequences of late neurosyphilis are difficult to treat and can destroy the psyche and body of a person.

The earliest signs of a personality disorder due to brain syphilis are easily confused with less dangerous mental disorders.

In adolescents and young people, early neurosyphilis can be mistaken for neurosis and depressive states, and in older people - for overwork or stress

Neurosyphilis- damage to the central nervous system (CNS) by infection resulting from the penetration of syphilis pathogens into it. Treponema pallidum is the source of infection and development of neurosyphilis. Neurosyphilis can appear at any stage of the syphilis disease.

Types of neurosyphilis: early, late, congenital

Pathology has three forms. In medicine, the following classification of neurosyphilis is accepted:

• early neurosyphilis: may be asymptomatic neurosyphilis, meningitis, spinal and cerebral syphilis.

It is quite difficult to diagnose an asymptomatic form of neurosyphilis, since there are no clinical signs. The disease develops in the first year after infection with syphilis. If the disease is not treated, then signs of improper functioning of the nervous system will appear.

Meningitis occurs in people who have syphilis. The disease affects the cranial nerves, sometimes vision is impaired, hearing problems occur. Maybe (hydrocele).

With spinal and cerebral syphilis, blood circulation in the brain is disturbed. Clinically, it looks like tissue damage with various symptoms. This type of syphilis can cause a stroke;

• late neurosyphilis. Diseases are of the following types: dorsal tabes, paralysis, atrophy of the optic nerves.

Paralysis begins to appear at least 5-10 years after infection enters the body. Pale treponema enters the brain and destroys cells. First, memory deteriorates, a person becomes irritable.

Problems with the optic nerves can be a form of neurosyphilis. First, atrophy of one eye begins, then the second. If the disease is not treated, then there is a risk of blindness.

Hummous neurosyphilis. Due to some inflammatory processes, dense formations occur, which are called gummas. They compress the nerves in the brain. This leads to paralysis;

• congenital neurosyphilis. It occurs quite rarely. Distinctive features: deafness, hydrocephalus, deformation of the teeth. Treatment stops the infectious process, but the symptoms remain forever.

Causes of the appearance and development of neurosyphilis

Neurosyphilis occurs as a consequence of ordinary syphilis. The spread of the neurosyphilis virus in the body depends on the stage of development of syphilis itself. There are three stages in the development of syphilis. Primary syphilis is characterized by hard chancre, secondary - with characteristic rashes. The development of neurosyphilis coincides with syphilis in the early stages - no more than 5 years have passed since the infection. The first year or two are especially dangerous. Syphilis, which is called tertiary, is almost not dangerous to the body. The virus is located deep enough, but if the gummas decay, the risk of infection becomes higher.

If there was contact with those infected with neurosyphilis, then the disease itself is not dangerous, there are problems with sexually transmitted processes, which then take place in the body. The virus is found in semen, blood, vaginal secretions, and saliva.

Ways of infection:

• the main route of infection is sexual intercourse, the virus enters the body through small lesions in the skin or mucous membranes. It does not matter what kind of sexual contact was. If you use condoms, then the risk of infection will decrease, but it will not be equal to zero. If sexual contact with a sick person was once, then the risk of infection is 50%;
• through the blood. Infection can occur through blood transfusion; if drug addicts use one injection syringe; when visiting a dentist and so on;
• domestic. Infection at the household level is extremely rare, but it happens;
• infection of a child from a sick mother;
• professional - the path of infection of medical staff who are in contact with patients and perform various operations with instruments. You can become infected during an operation or autopsy.

Contact with people who have neurosyphilis always carries some risk. If the disease occurs along with the primary or secondary form of ordinary syphilis, then the chance of contracting neurosyphilis is especially high. Minimal risk of infection only if neurosyphilis is a manifestation of the tertiary form of ordinary syphilis.

Symptoms and periods of development of neurosyphilis

If left untreated, syphilis will remain in the body for many years. There are several main periods:

• an incubation period that lasts up to 40 days from the moment of infection until a hard chancre appears;
• the primary period lasts up to 7 weeks: and before the formation of rashes;
• the secondary period can last several years. The infection spreads throughout the body. The nervous system may be affected, and these are already signs of neurosyphilis in the early stages. The meninges are also affected. Pale treponemas begin to penetrate the nervous system;
• the tertiary form occurs in almost half of patients after several years of illness.

Asymptomatic syphilis characterized by changes in the cerebrospinal fluid. There are no neurological problems. Most often, the disease is diagnosed after the detection of ordinary syphilis in the early stages. Outwardly, the disease has no symptoms.

Acute meningitis appears in the first two years after the person has been infected. Main signs: nausea, which is not caused by food, headaches, dizziness, high blood pressure. Sometimes a rash may occur. There may be cranial nerve problems. Another possible consequence is hydrocephalus.

Several months after infection may begin the development of meningovascular type of syphilis. Most often it occurs after many years of neglected syphilis. Large arteries begin to narrow, and small ones, on the contrary, expand. Possible stroke. Changes in behavior, sleep problems, dizziness are also observed. There may be disturbances in the functioning of the spinal cord.

Meningomyelitis is a disorder of the pelvic organs. Their deep sensitivity is disturbed. The symptoms can be quite severe.

Tabes dorsalis begins to appear after about 20 years. The disease occurs due to problems with the spinal cord. The main symptoms: sciatica, which is accompanied by severe pain, impotence, problems with the nervous system, the pupils narrow and become irregular in shape, there may be ulcers on the legs.

Paralysis begins to appear in the later stages of infection- sometimes even 10-15 years after infection. Treponemas penetrate the brain. Symptoms: impaired cognitive functions, there may be changes in behavior. Often there are manic states. The strength of the muscles decreases, the functions of the pelvic organs are disturbed. The disease is constantly progressing, can be combined with dryness.

Gumma compresses the cranial nerves. The disease is somewhat similar to brain damage. Sometimes it can be in the spinal cord. Symptoms of the disease: pressure rises, vision and hearing deteriorate, the functioning of the pelvic organs is disturbed.

Comprehensive diagnosis of neurosyphilis

To make a correct diagnosis, it is necessary to detect pale treponema in the body. Additionally, it is necessary to assess how severely the brain is affected. Diagnosis of the disease is complex. A neurological examination and blood tests are carried out. The clinical picture can be very different. Atypical forms of the disease are often encountered, which is why a comprehensive examination will be performed.

To diagnose neurosyphilis, two types of tests are done: treponemal and non-treponemal. Studies are carried out with blood and / or cerebrospinal fluid. But sometimes the tests give wrong results. For 100% detection of neurosyphilis, tests for the presence of treponema are performed. Also consult an ophthalmologist.

If there are no signs of brain compression, then a lumbar puncture is done - cerebrospinal fluid is collected from the spine. If there is an infection with neurosyphilis, then it will have pale treponemas, and the protein content will be noticeably higher than normal.

If necessary, computed or magnetic resonance imaging of the brain is done. This procedure allows you to identify pathologies that manifest as atrophy of the medulla or thickening of the membranes. This method is also used to determine gum.

Treatment of neurosyphilis at all stages of development

The method of treating neurosyphilis largely depends on the stage of the disease and how pronounced its symptoms are. Treatment is carried out only by a stationary method in a venereal dispensary under the supervision of doctors.

Patients who do not have immune problems prescribed drugs with penicillin to prevent the disease from progressing and developing. In the first two weeks, large doses of the drug are administered. If the patient is allergic to penicillin, it is replaced with antibacterial drugs.

If the disease is and the late stage, there are practically no effective drugs and methods of treatment. The disease may develop further. In order to prevent the disease from progressing, corticosteroids are used. Medicines are prescribed in several courses.

Every week during treatment, cerebrospinal fluid is analyzed for the presence of diseased cells. If they do not become smaller, then antibiotic treatment is prolonged.

Patients are prescribed vitamin complexes, medicines for blood vessels, means to strengthen the body.

The effectiveness of the chosen method of treating neurosyphilis is determined by how much the indicators of cerebrospinal fluid have improved. After normalization of the condition, the analysis of cerebrospinal fluid is taken once every six months. The last analysis is carried out 2 years after the start of treatment. If within 2 years new signs appear or old ones appear, a second course of treatment is carried out.

Consequences of neurosyphilis

The prognosis will be good if a person is diagnosed with the disease in the early stages. Early forms are treated without problems, the patient can completely get rid of the disease. Complications of neurosphilis can manifest as problems with the pelvic organs.

Late forms are more difficult to cure. If there is paralysis, then it can result in disability or even death. But the use of penicillin can stop the development of the disease.

If the spinal tabes is found, then the therapy will not give an effect. But the person will live. If syphilis is congenital, then there will be problems with the development of the body, deafness may appear. All this ultimately leads to disability.

Preventing neurosyphilis and minimizing the risk of infection

To minimize the risk of infection with pale treponema, you should be very careful about your sexual partners. It is best to avoid casual sex. It is very important to observe the rules of hygiene, especially in public places. If a person is infected with the treponema pallidum virus, he definitely needs to undergo regular examinations with a venereologist and a neurologist.

Neurosyphilis is a dangerous disease, so untimely assistance can lead to serious complications, which sometimes lead not only to problems with sexual life, but also to disability or death.

Neurosyphilis is an infectious disease of the human central nervous system. Its development is due to the penetration of the causative agent of syphilis into the nervous system. This complication can occur at any stage of the disease.

The reasons

The causative agent of neurosyphilis is pale treponema. Infection comes from a sick person. This usually happens during unprotected sex. The pathogen enters the body through lesions on the mucous membranes or skin. Further, pale treponema spreads in the body along with the bloodstream and lymph.

The body reacts to a foreign microorganism, the active production of antibodies begins. With a decrease in the protective properties of the blood-brain barrier (a structure that protects the brain from harmful factors in the blood), pale treponema is introduced into the central nervous system.

The development of neurosyphilis is facilitated by poor treatment of early forms of syphilis, severe emotional distress, mental fatigue, a general decrease in the body's immunity, alcoholism, drug addiction, chronic diseases of internal organs, and HIV infection.

Symptoms of neurosyphilis can be pronounced or erased, especially at the initial stage.

General signs of the disease:

• periodic occurrence of headaches and weakness;
• fast fatiguability;
• tingling in various parts of the body and numbness of the limbs;

The disease is characterized by the occurrence of the following conditions, each of which has its own symptoms:

• Acute syphilitic meningitis. There are signs of meningitis, nausea and vomiting. A maculopapular rash is added, cranial nerves are affected.
• Meningovascular syphilis. May present with sudden ischemic or hemorrhagic stroke. Violation of blood circulation leads to dizziness, emotional lability. The patient develops personality changes. Perhaps the formation of disorders in the system of arteries of the spinal cord.
• Syphilitic meningomyelitis. The patient has spastic lower paraparesis, deep sensitivity and functions of the pelvic organs are disturbed. In some cases, symptoms develop acutely and asymmetrically.
• Dorsal dryness. With this form of neurosyphilis, symptoms of sciatica occur with a pronounced pain syndrome, neurogenic trophic ulcers appear on the legs. A characteristic feature is a violation of deep sensitivity with a loss of reflexes.
• progressive paralysis. Symptoms are impaired thinking and memory, personality changes. Often there are depressive and manic states, hallucinations, delusional ideas. There is a tremor, a decrease in muscle tone, dysfunction of the pelvic organs, epileptic seizures.
• Syphilitic gum. The symptoms of this condition are similar to those of a massive brain lesion with intracranial hypertension. There is a lower paraparesis, the functions of the pelvic organs are disturbed.

Is neurosyphilis contagious?

The most contagious are patients with early forms of syphilis, especially in the first 2 years of illness. Patients with late forms of syphilis (lasting more than 5 years) are usually slightly contagious.

stages

Neurosyphilis is characterized by the presence of several stages:

• Latent - this stage has no clinical manifestations. But if you conduct a laboratory study of the patient's cerebrospinal fluid, then pathological changes are detected.
• Early - develops within two years after the disease with syphilis, against the background of primary or secondary infection. It happens that early neurosyphilis occurs even five years after infection. This condition is characterized by damage mainly to the membranes and vessels of the brain. Its manifestations include acute syphilitic meningitis, syphilitic meningomyelitis, and meningovascular neurosyphilis.
• Late neurosyphilis develops approximately 7 years after infection. It is characterized by an inflammatory-dystrophic lesion of the brain parenchyma. Late forms of the disease include progressive paralysis, dorsal tabes, syphilitic gumma of the brain.

Diagnostics

Diagnosis of neurosyphilis is carried out taking into account three main criteria. It:

• clinical picture;
• positive results of laboratory tests for syphilis;
• detection of changes in cerebrospinal fluid.

A correct assessment of the clinical picture of the disease is possible only after the neurologist conducts a complete examination of the patient. As for laboratory tests for the presence of syphilis, they are carried out comprehensively. Often there is a need to repeat them. Laboratory diagnostic methods include RIF, RPR-test, RIBT, as well as the detection of the pathogen - pale treponema in the contents of the affected skin elements.

In some cases, the patient is given a spinal (lumbar) puncture. With neurosyphilis, the cerebrospinal fluid contains pale treponemas and an excess of protein content.

Through MRI and CT of the spinal cord and brain, in the presence of a disease, such pathological changes are detected, such as thickening of the meninges, heart attacks, and atrophy of the brain substance.

Treatment of neurosyphilis is carried out only in the conditions of a dermato-venereological hospital. It involves the introduction of large doses of penicillin preparations into the body intravenously. This therapy continues for approximately two weeks.

The intravenous method of drug administration is due to the fact that intramuscular administration does not provide the necessary concentration of the antibacterial agent in the cerebrospinal fluid. If a patient with neurosyphilis has an allergic reaction to penicillin, then ceftriaxone or doxycycline is used.

At the beginning of therapy in the first days, a short-term worsening of neurological symptoms is possible, since there is a massive death of treponemas, and the release of their waste products into the blood. The patient has:

• intense headache;
• increase in body temperature;
• arterial hypotension;
• tachycardia.

The effectiveness of treatment is assessed by the regression of the symptoms of the disease and the improvement in performance in the study of cerebrospinal fluid. Patients are monitored for two years after the course of treatment. At the same time, the study of cerebrospinal fluid is carried out every six months.

At the stage of rehabilitation, patients are no longer treated by dermato-venereologists, but by neurologists and psychiatrists.

Forecast

The body of people with neurosyphilis usually responds well to treatment with penicillin. The only exception is the dorsal tabes, in which case the treatment is practically ineffective.

Subject to timely treatment, the prognosis is favorable for life. However, those parts of the brain that have been damaged will not fully recover. Therefore, consequences are possible in the form of muscle paresis, asthenia, impaired memory and attention.

Below is a video lecture on the problem of neurosyphilis:

Syphilis is a disease of a venereal nature that disrupts the functioning of some systems of internal organs. In the absence of competent treatment, neurosyphilis may develop after a short period of time, characterized by the penetration of infection into the nervous system. This is a pathology that is very dangerous for human health, threatening complete disability or death.

What is neurosyphilis?

Neurosyphilis is an infectious disease of the human central nervous system. The development of pathology is due to the penetration of the causative agent of syphilis into the body. The infection can involve in the pathological process all parts of the nervous system, starting with the brain and ending with the sense organs. Clinically, the disease is manifested by a number of neurological disorders: dizziness, muscle weakness, paralysis, convulsions, dementia.

For the first time, syphilis was discussed in the Middle Ages. In those days, alchemists did not yet know what neurosyphilis was. Participants of the Crusades suffered from the disease. During the Hundred Years' War, syphilis was otherwise called the French disease, as the British "brought" it from the mainland. A few decades ago, syphilis was considered a death sentence for the infected. Thanks to the rapid development of science, this disease can now be cured in a few weeks. However, neglected forms often cause death. High mortality for neurosyphilis is especially relevant.

The disease can manifest itself at any time during the development of a syphilitic infection. Diagnosis is based on the results of serological research methods and clinical manifestations. Treatment is usually with narrow-spectrum antibiotics. Today, the disease neurosyphilis is much less common than in the last century. This is due to the improvement in the quality of diagnostic measures, preventive examinations of the population, and early therapy.

The main causes of infection

The causative agent of neurosyphilis is the bacterium Treponema pallidum. Infection occurs directly from a sick person. This usually happens during unprotected intercourse. A pathogenic microorganism enters the human body through lesions on the mucous membranes or skin. The infection then spreads along with the bloodstream.

The body reacts to the foreign bacteria by producing antibodies. With a decrease in the blood-brain barrier, pale treponema is introduced into the nervous system. Thus, neurosyphilis gradually develops.

The causes of this pathology can also be non-specific. The development of the disease is facilitated by untimely treatment of early forms of the disease, emotional experiences, decreased immunity, traumatic brain injury, and mental fatigue.

The main routes of infection:

1. Sexual. This is the most common form of transmission. The causative agent penetrates through the mucous membranes and microdamages on the skin. The type of sexual contact usually does not play a special role. The use of barrier contraceptives (condom) reduces the risk of infection, but does not reduce it to zero.
2. Blood transfusion(during blood transfusion, dental procedures).
3. Domestic. Infection through the household requires very close contact with a sick person. Transmission through towels, shared household items, sharing a razor or brush cannot be ruled out.
4. Transplacental(transmission from mother directly to fetus).
5. Professional. First of all, this applies to medical workers who have constant contact with biological fluids (blood, semen, saliva). Infection is possible during obstetrics, surgical interventions, autopsy.

Any contact with a person infected with neurosyphilis always carries a threat.

Clinical picture

Signs of neurosyphilis may be pronounced or erased when the disease is at an early stage of development. Among the common symptoms characteristic of the disease, physicians include recurrent headaches, fatigue, numbness of the limbs.

Experts distinguish between early, late and congenital variant of the disease. The first develops within a few years from the moment of infection. Otherwise, it is called mesenchymal, since, first of all, the vessels and membranes of the brain are involved in the pathological process. The late form of the pathology manifests itself approximately five years after the penetration of pale treponema into the body. It is accompanied by damage to nerve cells and fibers. Congenital neurosyphilis develops as a result of transplacental transmission of infection from mother to fetus and manifests itself during the first months of a child's life.

Early neurosyphilis

This form of the disease usually develops within 2-5 years after the infection enters the body. This condition is accompanied by damage to the membranes and vessels of the brain. Its main manifestations include syphilitic meningitis, meningovascular syphilis, and latent neurosyphilis. The symptoms and characteristic features of each form will be discussed in more detail below.

Late neurosyphilis

This pathology is also divided into several forms:

• progressive paralysis.
• Dorsal dryness.
• Hummous neurosyphilis.
• Atrophy of the optic nerve.
• Meningovascular neurosyphilis (symptoms are similar to the early form of this disease).

When it comes to progressive paralysis, imply chronic meningoencephalitis. It usually develops 5-15 years after infection with syphilis. The main cause of this form of the disease is the penetration of pale treponema into the brain cells with their subsequent destruction. Initially, patients show changes in higher nervous activity (impairment of attention and memory, irritability). As the disease progresses, mental disorders (depression, delusions and hallucinations) join. Neurological symptoms include tongue tremor, dysarthria, and handwriting changes. The disease develops rapidly and within a few months leads to death.

With damage to the posterior roots and cords of the spinal cord, doctors talk about dorsal tabes. Clinically, the pathology manifests itself in the form of a loss of Achilles reflexes, instability in the result, a person's gait changes. The occurrence of atrophy of the optic nerve is not excluded. Trophic ulcers are another characteristic feature of the disease.

Atrophy in some cases acts as an independent form of such an ailment as neurosyphilis. The consequences of the disease significantly reduce the quality of human life. The initial pathological process affects only one eye, but after a while it becomes bilateral. Decreased visual acuity. In the absence of timely treatment, complete blindness develops.

Hummous neurosyphilis. Gummas are rounded formations that form as a result of inflammation caused by treponema. They affect the brain and spinal cord, squeezing the nerves. Clinically, the pathology is manifested by paralysis of the limbs and pelvic disorders.

Congenital neurosyphilis

This form of pathology is diagnosed extremely rarely. During pregnancy, the expectant mother repeatedly undergoes examinations to detect infections. If intrauterine infection has occurred, it is very easy to recognize it. The clinical picture is characterized by the same symptoms as in adult patients, with the exception of dorsal tabes.

The congenital form of the disease has its own distinctive symptoms. This is hydrocephalus and the so-called Hutchinson triad: deafness, keratitis and deformation of the upper incisors. Timely treatment can stop the infectious process, but neurological symptoms persist throughout life.

Diagnosis of neurosyphilis

What is neurosyphilis, we have already told. How to confirm this disease? The final diagnosis is possible taking into account three main criteria: a characteristic clinical picture, the results of tests for syphilis, and the detection of changes in the composition of the cerebrospinal fluid. An adequate assessment of the patient's condition is permissible only after a neurological examination.

As for laboratory studies, they are carried out in a complex manner. In some cases, multiple repetition of tests is required. The most informative methods of laboratory diagnostics include RPR analysis, RIBT, RIF, as well as the identification of the infectious agent in the contents of the affected skin areas.

In the absence of pronounced symptoms, it is carried out. In neurosyphilis, an increased level of protein and the causative agent of the disease, pale treponema, are found in the cerebrospinal fluid.

MRI and CT of the spinal cord are prescribed to all patients with suspected neurosyphilis. Diagnosis by means of special devices reveals hydrocephalus and atrophy of the medulla.

How to beat neurosyphilis?

Treatment of early forms of the disease is based on aggressive antibiotic therapy. For this, drugs of the penicillin and cephalosporin series are used. As a rule, therapy is complex and involves the use of several medications at the same time. The usual scheme: Penicillin, Probenecid, Ceftriaxone. All drugs are administered intravenously. Penicillin injections are also made into the spinal canal. The course of treatment usually lasts two weeks. After that, the patient undergoes a second examination, the results of which can be used to judge whether it was possible to defeat neurosyphilis. Treatment is prolonged if pale treponema is found in the cerebrospinal fluid.

On the first day of drug therapy, neurological symptoms (headache, fever, tachycardia) may increase. In such cases, treatment is supplemented with anti-inflammatory and corticosteroid drugs.

To combat the late form of neurosyphilis, drugs with arsenic and bismuth are used, which are highly toxic.

Forecast and consequences

Early forms of neurosyphilis respond well to therapy, and full recovery is possible. In some cases, the so-called residual effects in and paresis persist, which can cause disability.

Late forms of pathology are poorly amenable to drug therapy. Symptoms of a neurological nature, as a rule, remain with the patient for life.

Progressive paralysis was fatal until a few years ago. Today, the use of antibiotics of the penicillin series can mitigate the manifestation of symptoms and slow down neurosyphilis.

Photos of patients with such a diagnosis and after a course of treatment make it possible to understand what kind of threat the pathology poses to the body. That is why everyone should know how to prevent this disease.

Prevention measures

To prevent infection, doctors recommend giving up uncontrolled sexual intercourse. Special attention should be paid to personal hygiene. People infected with pale treponema must undergo preventive examinations by a neurologist without fail.

What is neurosyphilis? This is a dangerous disease characterized by damage to the central nervous system. In the absence of timely treatment, there is a high probability of developing life-threatening complications that directly affect the quality of life, and sometimes lead to death. Therefore, one should not neglect the prevention of the disease, and after infection, immediately seek help from a doctor.

Infectious lesion of the central nervous system, due to the penetration of syphilis pathogens into it. May occur during any period of syphilis. Neurosyphilis is manifested by symptoms of meningitis, meningovascular pathology, meningomyelitis, lesions of the posterior cords and roots of the spinal cord, progressive paralysis or focal lesions of the brain due to the formation of syphilitic gum in it. Diagnosis of neurosyphilis is based on the clinical picture, neurological and ophthalmological examination data, MRI and CT of the brain, positive serological reactions for syphilis, and the results of a CSF study. Treatment of neurosyphilis is carried out intravenously with large doses of penicillin preparations.

General information

Until a few decades ago, neurosyphilis was a very common complication of syphilis. However, mass examinations of patients for syphilis, timely detection and treatment of infected persons have led to the fact that modern venereology is less and less likely to encounter such a form of the disease as neurosyphilis, despite the fact that the incidence of syphilis is steadily growing. Many authors also believe that the decrease in cases of neurosyphilis is associated with a change in the pathogenic characteristics of its causative agent - pale treponema - including a decrease in its neurotropism.

Classification of neurosyphilis

Latent neurosyphilis does not have any clinical manifestations, but the examination of the patient's cerebrospinal fluid reveals pathological changes.

Early neurosyphilis develops against the background of primary or secondary syphilis, mainly in the first 2 years of the disease. But it can occur within 5 years from the time of infection. It proceeds with damage mainly to the vessels and membranes of the brain. Early manifestations of neurosyphilis include acute syphilitic meningitis, meningovascular neurosyphilis, and syphilitic meningomyelitis.

Late neurosyphilis occurs no earlier than 7-8 years from the moment of infection and corresponds to the period of tertiary syphilis. It is characterized by an inflammatory-dystrophic lesion of the brain parenchyma: nerve cells and fibers, glia. Late forms of neurosyphilis include dorsal tabes, progressive paralysis and syphilitic gumma of the brain.

Symptoms of neurosyphilis

Acute syphilitic meningitis characterized by symptoms of acute meningitis: severe headache, tinnitus, nausea and vomiting regardless of food intake, dizziness. Often occurs without a rise in body temperature. Positive meningeal symptoms are noted: neck stiffness, inferior Brudzinski's sign, and Kernig's signs. Increased intracranial pressure is possible. Neurosyphilis in the form of acute meningitis develops most often in the first few years of syphilis, during its relapse. It may be accompanied by skin rashes or be the only manifestation of a recurrence of secondary syphilis.

Meningovascular neurosyphilis develops with syphilitic damage to the vessels of the brain by the type of endarteritis. It manifests itself as an acute violation of the blood circulation of the head in the form of an ischemic or hemorrhagic stroke, a few weeks before which the patient begins to experience headaches, sleep disturbances, dizziness, personality changes appear. Perhaps the course of meningovascular neurosyphilis with impaired spinal circulation and the development of lower paraparesis, sensory disorders and disorders of the pelvic organs.

Syphilitic meningomyelitis proceeds with damage to the membranes and substance of the spinal cord. There is a slowly increasing spastic lower paraparesis, accompanied by a loss of deep sensitivity and dysfunction of the pelvic organs.

Dorsal tabes occurs due to syphilitic inflammatory lesions and degeneration of the posterior roots and cords of the spinal cord. This form of neurosyphilis appears on average 20 years after infection. It is characterized by sciatica with severe pain syndrome, loss of deep reflexes and deep types of sensitivity, sensitive ataxia, neurotrophic disorders. With neurosyphilis in the form of dorsal tabes, impotence may develop. Neurogenic trophic ulcers on the legs and arthropathy are observed. Argyle-Robertson syndrome is characteristic - irregularly shaped constricted pupils that do not respond to light. The above symptoms may persist after specific therapy for neurosyphilis.

progressive paralysis may appear in patients with 10-20 years of disease. This variant of neurosyphilis is associated with the direct penetration of pale treponema into brain cells with their subsequent destruction. It is manifested by gradually increasing personality changes, memory impairment, impaired thinking up to the onset of dementia. Often there are mental deviations such as depressive or manic states, hallucinatory syndrome, delusional ideas. Neurosyphilis in the form of progressive paralysis may be accompanied by epileptic seizures, dysarthria, pelvic dysfunction, intentional tremor, and decreased muscle strength and tone. Perhaps a combination with manifestations of dorsal dryness. As a rule, patients with similar symptoms of neurosyphilis die within a few years.

syphilitic gumma localized most often at the base of the brain, which leads to compression of the roots of the cranial nerves with the development of paresis of the oculomotor nerves, atrophy of the optic nerves, hearing loss, etc. As the gumma grows in size, intracranial pressure increases and signs of compression of the brain substance increase. Less often, gumma in neurosyphilis is located in the spinal cord, leading to the development of lower paraparesis and dysfunction of the pelvic organs.

Diagnosis of neurosyphilis

The diagnosis of neurosyphilis is made taking into account 3 main criteria: the clinical picture, positive test results for syphilis, and identified changes in the cerebrospinal fluid. A correct assessment of the clinic of neurosyphilis is possible only after a neurologist conducts a complete neurological examination of the patient. Important additional information for the diagnosis of neurosyphilis is provided by the study of vision and examination of the fundus, which is carried out by an oculist.

Laboratory tests for syphilis are used comprehensively and, if necessary, repeatedly. These include RPR test, RIF, RIBT, detection of pale treponema with the contents of skin elements (if any). In the absence of symptoms of brain compression, a patient with neurosyphilis undergoes a lumbar puncture. The study of cerebrospinal fluid in neurosyphilis reveals pale treponema, high protein content, inflammatory cytosis over 20 µl. Carrying out RIF with cerebrospinal fluid, as a rule, gives a positive result.

MRI of the brain and CT of the brain (or spinal cord) in neurosyphilis reveal mostly non-specific pathological changes in the form of thickening of the meninges, hydrocephalus, atrophy of the brain substance, heart attacks. With their help, it is possible to identify the localization of gumma and differentiate neurosyphilis from other diseases similar in clinic.

Differential diagnosis of neurosyphilis is carried out with meningitis of another origin, vasculitis, brucellosis, sarcoidosis, borreliosis, tumors of the brain and spinal cord, etc.

Treatment of neurosyphilis

Therapy of neurosyphilis is carried out in stationary conditions by intravenous administration of large doses of penicillin preparations for 2 weeks. Intramuscular penicillin therapy does not provide a sufficient concentration of the antibiotic in the cerebrospinal fluid. Therefore, if intravenous therapy is not possible, intramuscular administration of penicillins is combined with taking probenecid, which inhibits the excretion of penicillin by the kidneys. In patients with neurosyphilis who are allergic to penicillin, ceftriaxone is used.

On the first day of treatment for neurosyphilis, a temporary aggravation of neurological symptoms may occur, accompanied by a rise in body temperature, intense headache, tachycardia, arterial hypotension, arthralgia. In such cases, penicillin therapy for neurosyphilis is supplemented with the appointment of anti-inflammatory and corticosteroid drugs.

The effectiveness of treatment is assessed by the regression of the symptoms of neurosyphilis and the improvement in cerebrospinal fluid. The control of the cure of patients with neurosyphilis is carried out for 2 years by examining the cerebrospinal fluid every six months. The appearance of new neurological symptoms or the growth of old ones, as well as persistent cytosis in the cerebrospinal fluid, are indications for a repeated course of neurosyphilis treatment.