A 55 year old retired Navy Master Chief is brought into the ER by his young girl

Question

A 55 year old retired Navy Master Chief is brought into the ER by his young girlfriend. She states that her boyfriend has had an increase in lapses of memory and he is “walking funny” despite no recent trauma. While you are talking to the girlfriend, the patient interjects and states that he has been experiencing a lot of numbness in his fingers and lower extremities is significant for ataxia and Argyll Robertson pupil.

Which laboratory test is used as a screening test for this condition? Which laboratory test is specific and will confirm the presence or absence of this condition?

What procedure would you request be performed on this patient?

For this condition, what would you expect to the “typical” results?

What is the most likely Diagnosis?

What is the prognosis if untreated?

What is the drug of choice?

Explanation / Answer

Answer: By seeing the above mentioned symptoms the patient must be having Neurosyphilis.

Neurosyphilis

Neurosyphilis is a bacterial infection of the brain or spinal cord .It usually occurs in people who have an untreated syphilis for many years.

Causes:

Neurosyphilis is caused by treponema pallidum.this is the bacteria that causes syphilis.It usually occurs about 10 to 20 years after a person is first infected with syphilis.

Symptoms:

Symptoms usually affect the nervous system

1.Abnormal walk

2.Numbness in toes,feet or legs

3.Problems with thinking,such as confusion or poor concentration

4.Mental problems ,such as depression or irritability

5.Visual problems,even blindness

6.Headache,tremors,loss of bladder control

Exams and tests:

1.Abnormal reflexes

2.Muslce atrophy

3.Muscle contractions

4.Mental changes

Blood tests :

1.Venereal disease research laboratory (VDRL) test.

2.Fluorescent treponemal antibody absorption (FTA-ABS)

3.Rapid plasma reagin (RPR)

4.Treponema pallidum particle agglutination assay (TPPA)

With neurosyphilis it is important to test the spinal fluid for signs for syphilis.

Tests to look for problems with the nervous system include:

1.Cerebral angiogram

2.Head CT scan

3.Lumbar puncture and CSF fluid analysis

4.MRI scan of the brain ,brain stem ,or spinal cord.

Treatment:

The antibiotic penicillin is used to treat neurosyphilis ,It can be given in different ways

-Injected into 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 and followed by regular blood tests and check ups.

Prognosis:

Neurosyphilis is a life threathening complication of syphilis.

Possible complications:

-The symptoms can slowly worsen.

Prevention:

Prompt diagnosis and treatment of original syphilis infection can prevent neurosyphilis.

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