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</div><div><span>Neurosyphilis</span></div></div>
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</a><h1 class="with-also" itemprop="name">Neurosyphilis</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Neurosyphilis is a bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated <a test="test" href="./000861.htm">syphilis</a> for many years.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>Neurosyphilis is caused by <em>Treponema pallidum </em>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.</p><p>There are four different forms of neurosyphilis:</p><ul><li><a test="test" href="./002217.htm">Asymptomatic</a> (most common form)</li><li><a test="test" href="./000748.htm">General paresis</a></li><li>Meningovascular</li><li><a test="test" href="./000729.htm">Tabes dorsalis</a></li></ul><p>Asymptomatic neurosyphilis occurs before <a test="test" href="./002293.htm">symptomatic</a> syphilis. Asymptomatic means there aren't any symptoms.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms usually affect the nervous system. Depending on the form of neurosyphilis, symptoms may include any of the following:</p><ul><li><a test="test" href="./003199.htm">Abnormal walk</a> (gait), or unable to walk</li><li>Numbness in the toes, feet, or legs</li><li>Problems with thinking, such as confusion or poor concentration</li><li>Mental problems, such as depression or irritability</li><li>Headache, <a test="test" href="./003200.htm">seizures</a>, or stiff neck</li><li>Loss of bladder control (<a test="test" href="./003142.htm">incontinence</a>)</li><li>Tremors, or weakness</li><li><a test="test" href="./003029.htm">Visual problems</a>, even blindness</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Your health care provider will do a physical examination and may find the following:</p><ul><li>Abnormal reflexes</li><li><a test="test" href="./003188.htm">Muscle atrophy</a></li><li>Muscle contractions</li><li>Mental changes </li></ul><p>Blood tests can be done to detect substances produced by the bacteria that cause syphilis, this includes: </p><ul><li><em>Treponema pallidum</em> particle agglutination assay (TPPA)</li><li>Venereal disease research laboratory (<a test="test" href="./003515.htm">VDRL</a>) test</li><li>Fluorescent treponemal antibody absorption (<a test="test" href="./003512.htm">FTA-ABS</a>)</li><li>Rapid plasma reagin (<a test="test" href="./003533.htm">RPR</a>)</li></ul><p>With neurosyphilis, it is important to test the spinal fluid for signs of syphilis.</p><p>Tests to look for problems with the nervous system may include:</p><ul><li><a test="test" href="./003799.htm">Cerebral angiogram</a></li><li><a test="test" href="./003786.htm">Head CT scan</a></li><li><a test="test" href="./003428.htm">Lumbar puncture</a> (spinal tap) and <a test="test" href="./003369.htm">cerebrospinal fluid (CSF) analysis</a></li><li><a test="test" href="./003335.htm">MRI</a> scan of the brain, brainstem, or spinal cord </li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>The antibiotic penicillin is used to treat neurosyphilis. It can be given in different ways:</p><ul><li>Injected into a vein several times a day for 10 to 14 days.</li><li>By mouth 4 times a day, combined with daily muscle injections, both taken for 10 to 14 days. </li></ul><p>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.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>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 are not reversible.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>The symptoms can slowly worsen.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider if you have had syphilis in the past and now have signs of nervous system problems.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>Prompt diagnosis and treatment of the original syphilis infection can prevent neurosyphilis.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Syphilis - neurosyphilis</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/8679t.jpg" alt="Central nervous system and peripheral nervous system" title="Central nervous system and peripheral nervous system" class="side-img"/><a href="../imagepages/8679.htm">Central nervous system and peripheral nervous system</a></li>
<li><img src="//medlineplus.gov/ency/images/ency/tnails/8955t.jpg" alt="Late-stage syphilis" title="Late-stage syphilis" class="side-img"/><a href="../imagepages/8955.htm">Late-stage syphilis</a></li>
</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Euerle BD. Spinal puncture and cerebrospinal fluid examination. In: Roberts JR, Custalow CB, Thomsen TW, eds. <em>Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care</em>. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 60.</p><p>National Institute of Neurological Disorders and Stroke website. Neurosyphilis. <a href="https://www.ninds.nih.gov/health-information/disorders/neurosyphilis" target="_blank">www.ninds.nih.gov/health-information/disorders/neurosyphilis</a>. Updated July 19, 2024. Accessed September 8, 2024.</p><p>Radolf JD, Tramont EC, Salazar JC. Syphilis (Treponema pallidum). In: Bennett JE, Dolin R, Blaser MJ, eds. <em>Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases</em>. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 237.</p></div></div></section>
<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 12/4/2022</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Jatin M. Vyas, MD, PhD, Associate 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. Editorial update 09/08/2024.</p>
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