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Danger of syphilitic brain damage. Neurosyphilis: forms of pathology and therapeutic tactics Neurosyphilis burning of the head in the sun

Neurosyphilis is a lesion of the nervous system caused by Treponema pallidum. The pathological process manifests itself in secondary and tertiary forms of syphilis, which occur in the absence of timely and adequate treatment. Pathogens enter the bloodstream, lymph flow and nervous tissue - this is the cause of the development of neurosyphilis.

The incidence of neurosyphilis is 0.3-0.4 per 100 thousand population. 15-20% of patients infected with syphilis suffer from pathology of the nervous system. The disease accounts for 8-9% of all organic disorders of the nervous system caused by brain damage.

Treponema pallidum, the causative agent of the pathology, is transmitted primarily through sexual contact. The disease results from a spread called syphilis (lues).

An STD occurs in several stages. The patient is contagious in the primary and secondary forms, in the presence of chancre and rashes.

Neurosyphilis develops deep within the body and cannot be transmitted. The exception is when gummas form on the skin.

The infection is transmitted through blood during transfusion or intravenous injections using a single syringe. The spread of infection is possible at any stage of the disease.

Congenital neurosyphilis occurs in infants when spirochetes are transmitted from mother to fetus through the placenta, during childbirth, and is extremely rare. Women are examined during pregnancy, and the pathogen can be identified in advance. The child is prescribed syphilis therapy immediately after birth.

Household transmission of spirochetes is theoretically possible, but in practice it is rare. In a humid environment, treponema pallidum lives for several hours, but on a dry and hot surface it quickly dies; antiseptics also kill it.

There are 2 forms of the disease: early and late. Early is divided into the following types:

meningitis - inflammation of the membranes of the brain;
meningomyelitis - inflammation of the membranes, substance and spinal roots;
meningoencephalomyelitis - inflammation of the membranes and substance of the brain and spinal cord;
polyneuritis - multiple inflammation of the nerves;
endarteritis or meningovascular neurosyphilis - inflammation of large vessels and their narrowing;
gummous neurosyphilis - the formation of deep ulcers that heal with the formation of scars.

Late disease is divided into the following types:

tabes dorsalis - inflammation of the posterior columns of the spinal organ and spinal roots;
progressive paralysis or Bayle's disease - mental pathology with the development of dementia, together with somatic and neurological disorders;
amyotrophic spinal syphilis - damage to the membranes and anterior roots of the spinal cord.

There is a concept of asymptomatic (latent) neurosyphilis, when symptoms of the disease do not occur, but are diagnosed by changes in the cerebrospinal fluid (CSF). Pathology is the only neuroinfection in which, in the absence of pronounced symptoms, a change in the cerebrospinal fluid is noted. Then the development of meningitis, meningoencephalitis, vascular pathology and the formation of gummas occurs.

Damage to the lining of the brain

Neurosyphilis begins with meningitis, brain damage. As it develops, it can be acute or subacute, chronic and gummous. At the initial stage, it may be asymptomatic or accompanied by the following symptoms:

Asthenic syndrome or increased fatigue.
Absent-mindedness, bad mood, forgetfulness, irritability.
Decreased mental activity, slowing down of mental processes.
Senesthopathy is unpleasant sensations throughout the body.
Insomnia.
Speech and movement disorders.
Symptoms of meningitis are headache, vomiting, fever, tachycardia, convulsions, etc.

If there are no symptoms, serological tests of the cerebrospinal fluid will help detect the disease. With neurosyphilis, an increase in leukocytes, protein and polynuclear cells is observed.

Exacerbation of syphilitic meningitis

At the initial stage of syphilitic meningitis, there are no specific symptoms of inflammation. In the secondary period, the symptoms of meningitis increase. The pathology is accompanied by the following symptoms:

a sharp increase in body temperature to 38;
headaches and tinnitus;
dizziness and weakness;
nausea and vomiting;
photophobia.

The disease lasts 10-15 days; if left untreated, it becomes chronic and develops. The disease develops 4-5 years after infection with spirochetes and occurs without pronounced symptoms. The patient experiences headaches, especially at night. The oculomotor nerve suffers, which leads to impaired visual function and strabismus.

Basal meningitis

This form of brain inflammation occurs in a chronic form with periodic remissions; the lower part of the organ is affected. The diagnosis is made by complaints of prolonged headaches and damage to the cranial nerves. In case of pathology, the following signs are of concern:

frequent urination and thirst due to dysfunction of the pituitary gland, symptoms of non-diabetes mellitus;
Pechkranz syndrome - progressive obesity;
acromegaly - changes in appearance and well-being due to increased production of growth hormone.

The pathology is accompanied by general cerebral symptoms: changes in the level of consciousness, headaches and vomiting, dizziness and convulsions. Sometimes focal signs appear: speech and movement disorders, paralysis, paresis, lack of sensitivity.

Damage to the dura mater of the brain

Inflammation of the hard membrane is almost always accompanied by damage to the soft membrane, and manifests itself in the form of cerebral syphilitic pachymeningitis. The pathology occurs in acute and chronic stages, and according to the nature of the course it can be purulent, serous and hemorrhagic.

The serous form is asymptomatic. With hemorrhagic manifestations depend on the degree of damage. With extensive hemorrhage, severe headache, vomiting, delirium and impaired mental function occur.

The pathological process is accompanied not only by inflammation, but also by the proliferation of connective tissue and thickening of the meninges, the formation of a hematoma tumor. The patient suffers from stroke and paralysis. A change in an organ at an advanced stage leads to the death of the patient.

Spinal cord lesion

Neurosyphilis affects the hard and soft membranes of the spinal cord. The disease of hard membranes occurs in 3 stages:

inflammation of the roots;
loss of sensitivity;
organ compression.

Inflammation of the soft membranes can be widespread and focal.

The acute stage of spinal cord damage is accompanied by the following symptoms:

increased body temperature;
pain in the back of the head and neck, back, lower back;
pain and lack of sensitivity in the ulnar and median nerves;
muscle atrophy, paresis, paralysis;
Klumpke's paralysis - the disease affects the hands;
formation of bedsores.

When the disease occurs, dysfunction of the spine and pain occur, the patient is in a forced position, and meningeal symptoms may appear.

The chronic stage of organ damage is recorded more often and is accompanied by the following disorders:

Meningoradiculitis is inflammation of the membranes and roots.
Meningomyelitis is an inflammation of the membranes, roots and substance of the spinal cord.

The chronic inflammatory process can be asymptomatic, in which case the disease is diagnosed by cerebrospinal fluid.

Damage to cerebral vessels

Vascular neurosyphilis is accompanied by damage to the soft membranes and cranial vessels. Accompanied by depression of blood circulation, mental disorders, and the development of paralysis. At the same time, as paralysis progresses, mental abnormalities become less pronounced, the disease manifests itself in the form of spontaneous remissions and exacerbations. Damage to large vessels is reversible if the pathology is diagnosed at an early stage.

Inflammation of the blood vessels of the brain is accompanied by the following symptoms:

stroke;
pathology of speech and motor function;
epileptic seizures;
general cerebral signs;
paresis, loss of sensitivity;
mental disorders - euphoria, delirium, memory problems, verbal hallucinations (auditory).

Damage to blood vessels in the back area is very dangerous. The pathology occurs secretly and asymptomatically. The patient slowly loses sensitivity and develops paresis. Different parts of the body are affected, depending on the affected area of the spine.

Tabes dorsalis

Syphilitic myelopathy or tabes dorsalis is an advanced stage of the disease, which develops 10-12 years after infection, against the background of a complete lack of treatment. Occurs in 3% of those infected with spirochetes, and in 20% of patients with neurosyphilis.

Men get sick more often than women, and the first signs of tabes dorsalis appear in patients after 30-40 years. Tabes dorsalis is a pathological change in the spinal cord.

The pathology is accompanied by the following symptoms:

paresthesia;
severe cutting pain in the limbs and torso;
hypothalamic crises with increased temperature;
when the gastrointestinal tract is affected, rapid weight loss is observed;
decreased sensitivity;
poor coordination of movements;
disturbance of urinary function and defecation;
damage to the optic and auditory nerves.

The severity of symptoms depends on the degree of damage to the spinal cord and spinal area. In the last stages, complete atrophy of the limbs is observed, the person cannot move independently.

Taboparalysis

The pathology is a combination of tabes dorsalis and progressive paralysis. It is accompanied by disorders characteristic of myelopathy and progressive paralysis, but occurs in a milder form, as it develops slowly.

First, spinal manifestations characteristic of tabes dorsalis occur, and after 5-10 years insanity, visual hallucinations, and paranoid psychosis begin to occur. The symptoms are similar to alcoholic encephalopathies, so differential diagnosis is required.

Progressive paralysis

Paralytic dementia, which has many forms. The most common is dementia, in which there is an increase in dementia with complete indifference to what is happening and others, a decrease in memory, all this is accompanied by ridiculous actions. The patient does not remember his own address and name, and is unable to learn.

There is also a manic form, with delusional ideas of greatness. The patient is sure that he is the Lord of the World, there is euphoria and causeless joy. In the depressive form, on the contrary, the patient blames himself for all the negative phenomena occurring on the planet and suffers from tearfulness and low mood. Manic and depressive forms can change each other, then the circular type is diagnosed.

The most severe stage is complete dementia. The patient cannot take care of himself, makes illogical conclusions, and does not answer questions. At the same time, sudden mood changes occur from euphoria to complete apathy. In severe cases, marasmus develops, swallowing functions disappear, and involuntary urination and defecation occur.

Gumma brain

Gummous nodes form in the hard and soft membranes of the brain and spinal cord, grow into the organ, and compress it. At first, gumma is a tumor, which over time disintegrates in the center and turns into an ulcer. Gumma causes necrosis of the affected tissue, and after healing it forms an area of sclerosis, that is, a scar.

Ulcers develop 5 years after infection with Treponema pallidum, in the absence of treatment. The disease is accompanied by headaches and vomiting, impaired visual and auditory function, epileptic seizures, and paralysis. Clinical signs largely depend on the location of the gumma.

Congenital neurosyphilis

Juvenile neurosyphilis is a very rare disease that occurs as a result of the progression of congenital syphilis.

As a rule, the infection is diagnosed in the maternity hospital, immediately after the birth of the child. There, the neonatologist prescribes specific antibiotic therapy, and the child is cured.

If untreated, neurosyphilis manifests itself up to 2 years of age, accompanied by symptoms of tertiary syphilis and deviations in the development of the child. Requires long-term rehabilitation after primary treatment.

The pathology is often asymptomatic, with negative serological reactions, which greatly complicates diagnosis. Cerebrospinal fluid and blood samples must be examined carefully.

The following diagnostic methods are used:

History taking and neurological examination.
Serological studies of cerebrospinal fluid - PRP, RIF, ELISA, RPGA.
Spinal function for collection and examination of cerebrospinal fluid.

Treatment methods

Treat the pathological process. The drug of choice is penicillin, since Treponema pallidums are not resistant to it. The treatment regimen is drawn up individually, depending on the stage of the disease. An example of a treatment regimen for early forms of neurosyphilis:

Benzylpenicillin intravenously, 2-4 ml units 6 times a day, for 2 weeks. Or intramuscular benzylpenicillin novocaine salt, 2 million units per day, divided into 4 doses.
Prednisolone 60-90 mg for 3 days, as an anti-inflammatory and analgesic.

Neurosyphilis is a sexually transmitted disease that disrupts the functioning of some internal organs, and if left untreated, spreads to the nervous system in a short time. Can occur at any stage of the course. The development of the disease is accompanied by attacks of severe pain, muscle weakness,... Dementia and paralysis of the limbs are common.

Infection occurs through sexual contact, after which the infection spreads throughout the body with blood flow. As the pathological process develops, the number of antibodies decreases, after which the virus attacks the nervous system.

The disease can be either acquired or congenital.

Etiology of the disease

The main factor in the occurrence of the disease is the bacterium Treponema pallidum. This means that the infection comes from an infected person.

The main ways of spreading the infection:

Factors predisposing to disease progression:

untimely treatment of syphilis;
mental stress;
frequent stress or strong emotional outburst;
brain injuries;
weakened;
At risk are medical workers who are constantly in contact with various human biological secretions: blood, saliva or sperm. Infection can occur during surgery or childbirth.

Patients who experience the disease in its early stages are considered to be the most contagious. People whose illness has lasted five years or more are less at risk.

Forms of neurosyphilis

In medicine, neurosyphilis is divided depending on the duration of infection. So they distinguish:

The disease is characterized depending on the severity of symptoms and there are several forms:

latent– often diagnosed accidentally during a routine examination. There are no symptoms of the disease, and the virus is detected by examining the cerebrospinal fluid;
syphilitic meningitis– mainly observed in young people. Main symptoms: a, weakness, decreased visual acuity;
tabes dorsalis– damage occurs to the cords and roots of the spinal cord;
meningovascular neurosyphilis– blood circulation in the brain is impaired. It is observed that problems with sleep arise;
gummatous neurosyphilis– characterized by progressive paralysis. This form occurs with late neurosyphilis.

If diagnosis is not made in time and treatment is not started, the disease can lead to disability, complete paralysis and death.

Symptoms of neurosyphilis

For each form of the disease there are specific signs.

Symptoms of early neurosyphilis:

attacks and;
decreased sensitivity of the pelvic organs;
strong and
decreased visual and hearing acuity;
against the background of night cramps, sleep disturbances occur;
and concentration;
muscle weakness.

Symptoms of late neurosyphilis:

complete loss of vision initially in one eye, and then, as the blindness progresses, it becomes bilateral;
hallucinations;
increased irritability;
inappropriate behavior;
changes in gait and handwriting;
tongue tremor;
increase in body temperature.

Gradually, the disease leads to paralysis, seizures and dysfunction of the pelvic organs.

Symptoms of congenital neurosyphilis:

With timely diagnosis and proper treatment of the congenital form, the progression of the infection can be stopped, but the consequences of nervous system disorders will remain for life.

Diagnosis of the disease

Neurosyphilis is diagnosed based on the clinical picture, laboratory examination of the cerebrospinal fluid and a positive test result. Also important is a neurological examination, laboratory blood tests (RIBT and RIF) and examination of the patient by an ophthalmologist. In some cases, blood tests are performed more than once.

In the latent stage of neurosyphilis, cerebrospinal fluid is examined.

Examinations of either the spinal cord or brain can detect pathological changes in the membranes of these organs, as well as the location of the infection. An important part of diagnosis is differentiating neurosyphilis from other diseases with similar symptoms. These include: malignant and spinal cord, sarcoidosis, of various natures.

Treatment of neurosyphilis

Treatment of the disease is carried out only in a hospital. Special drugs with a high content of penicillin are injected into the patient's body..

The duration of treatment is at least two weeks. For greater absorption, probenecid is additionally prescribed, a substance that inhibits the excretion of penicillin by the kidneys. Patients who are allergic to this drug are prescribed ceftriaxone. On the first day of therapy with this medicine, body temperature increases, heart rate increases, and unbearable headaches occur.

In addition to penicillin, corticosteroids and anti-inflammatory drugs are prescribed.

The degree of expression of the symptoms of the disease and improvement in the condition of the cerebrospinal fluid are the criteria by which the effectiveness of therapy is assessed. At the end of treatment, the patient's condition is monitored for two years. To do this, cerebrospinal fluid is examined every six months. If new symptoms arise or old ones worsen, a repeat course of drug therapy is prescribed.

At an early stage, the disease can be almost completely eliminated. With severe damage to nerves and blood vessels, some symptoms may remain with the patient for life. The congenital form entails lifelong deafness, and sometimes disability.

To exclude the possibility of infection, it is enough to carefully follow personal hygiene procedures, avoid unprotected sexual contact, and also do not share things and equipment with an infected person.

In the development of neurosyphilis, the main role is played by the absence or insufficient previous antisyphilitic treatment, trauma (especially traumatic brain injury), intoxication, chronic infections, and disorders of the immune status of the patient’s body. From a clinical point of view, it is advisable to distinguish between: syphilis of the central nervous system, syphilis of the peripheral nervous system, functional nervous and mental phenomena in syphilis.

Syphilis of the central nervous system . This disease is closely associated with a wide variety of (localized or diffuse) syphilitic processes in the brain or spinal cord. They can be either vascular or localized in the medulla. In early periods they can be acute or subacute inflammatory, in later periods - limited or diffuse inflammatory or gummous, and in some cases - inflammatory-degenerative (for example, with vascular lesions).
Clinically, syphilis of the central nervous system can manifest itself as a picture of meningitis, meningoencephalitis, meningomyelitis, endarteritis, or gummous processes that give symptoms of a tumor.
There are early syphilis of the nervous system (up to 5 years from the moment of infection) and late neurosyphilis (no earlier than 6-8 years after infection). Early neurosyphilis is called mesenchymal, since the membranes and blood vessels of the brain are affected, the mesenchymal reaction predominates; sometimes parenchymal elements are involved in the process, but secondary. Late neurosyphilis is called parenchymal, due to damage to neurons, nerve fibers, and neuroglia. The changes are inflammatory-dystrophic in nature, the mesenchymal reaction is not expressed.

Early neurosyphilis. Latent syphilitic meningitis occurs in 10-15% of patients with primary and 20-50% of patients with secondary fresh, secondary recurrent and early latent (early and late phases) syphilis. In this case, as a rule, there are no clinical symptoms. Sometimes headaches, dizziness, tinnitus, decreased hearing acuity, and pain when moving the eyeballs are observed. Hyperemia and neuritis of the optic disc are even less common. The diagnosis of latent meningitis in patients with early syphilis is established by changes in the cerebrospinal fluid (usually an increase in the amount of proteins, cytosis).

The meningoneurotic form of syphilitic meningitis (basal meningitis) occurs in 10-20% of all cases of early neurosyphilis. It proceeds subacutely. Mild meningeal symptoms are noted: mild headache, worse at night, dizziness, sometimes nausea, vomiting. As a result of damage to the oculomotor, abducens, and vestibulocochlear nerves, mild ptosis, facial asymmetry, smoothness of the nasolabial folds, deviation of the tongue, prolapse of the soft palate, and decreased bone conduction are observed. Minor changes in the cerebrospinal fluid are detected. When the optic nerve is involved in the process (usually bilateral), central vision deteriorates and visual fields narrow. The optic disc is hyperemic, its boundaries are unclear, the disc tissue swells slightly, the veins dilate (the arteries change little). Psychogenic reactions occur predominantly in the form of mild depression, combined with anxiety (syphilitic neurasthenia). Sometimes asthenic disorders are dominated by excitability, irritability and persistent deterioration in mood, accompanied by anxiety.

Syphilitic hydrocephalus occurs in 7-15% of all cases of early neurosyphilis and is caused by local inflammation of the meninges. Acute syphilitic hydrocephalus is characterized by increasing headache, dizziness, uncontrollable vomiting, confusion, stupor, and sometimes delirious syndrome. In some cases, there may be epileptiform seizures (epileptiform syndrome), speech disorders. An ophthalmological examination reveals a congestive optic disc. After lumbar puncture, the patient's condition improves. Protein-cell dissociation is detected in the cerebrospinal fluid. Chronic syphilitic hydrocephalus is more common than acute. It is characterized by persistent headache, dizziness, congestive optic disc, protein-cell dissociation and temporary reduction or cessation of headache after lumbar puncture, while other symptoms of acute hydrocephalus are absent.

Acute generalized (manifest) syphilitic meningitis - a rare disease that begins with an increase in body temperature, accompanied by a severe headache, dizziness, and vomiting. Meningeal symptoms, pathological reflexes (Babinsky, Oppenheim, Rossolimo), as well as hyperemia of the optic nerve head (bilateral), papillitis are expressed. Sometimes there are circulatory disorders, accompanied by epileptiform seizures, confusion, paresis of the limbs, damage to the oculomotor, abducens, and facial nerves. A large amount of protein and cells are determined in the cerebrospinal fluid. This form of early neurosyphilis develops at 5-6 months. from the moment of infection during the period of rashes of secondary recurrent syphilis or without them.

Syphilitic meningomyelitis is currently rare (up to 0.5% of all cases of early neurosyphilis). The disease occurs 1-3 years after infection. May be acute. In this case, paralysis of the lower extremities develops with a profound disturbance of trophism, decreased or loss of sensitivity, and dysfunction of the pelvic organs. Syphilitic meningomyelitis is difficult to respond to specific therapy.
In early meningovascular syphilis, the meninges are moderately involved in the process. The clinical picture is varied; includes headache, damage to cranial nerves, sensory disturbances, hemiparesis, alternating paralysis, epileptiform seizures, apoplectiform syndrome, memory impairment, aphasia, etc. Symptoms are caused by syphilitic endarteritis.
The following forms of late neurosyphilis are distinguished: late latent (latent) syphilitic meningitis, late diffuse meningovascular syphilis, cerebral syphilis (vascular syphilis), tabes dorsalis, progressive paralysis, cerebral gumma.

Late latent syphilitic meningitis appears in untreated or insufficiently treated patients with syphilis or in individuals resistant to therapy. The disease is characterized by positive Lange and Wasserman reactions in the cerebrospinal fluid, as well as the absence of a pronounced effect from specific therapy in most patients. This form of neurosyphilis contributes to the development of late diffuse meningovascular syphilis, tabes dorsalis, progressive paralysis.

Late diffuse meningovascular Syphilis is currently diagnosed quite often. Develops 10-25 years after infection. Initially, the disease is usually benign; characterized by cyclicity with spontaneous remissions. Persistent but mild headache, dizziness, hemiparesis, epileptiform seizures, alternating paralysis, speech and memory disorders, personality asthenia, etc. are noted. Hemiplegia, most often, occurs as a result of specific artermitis of one of the branches of the carotid or vertebral arteries

A rheovasographic study reveals heterogeneous changes in the blood vessels of different areas of the arms and legs; during an electroencephalographic study, the predominance of the irritation process against the background of low bioelectrical activity is noted. Changes in the cerebrospinal fluid are insignificant, RIBT and RIF in the blood and cerebrospinal fluid are positive, while serological reactions in the blood may be negative. Epileptiform and apoplectiform syndromes are often combined. Seizures occur according to the Jacksonian type, but sometimes transform into generalized ones, up to the development of status epilepticus.

Syphilis of cerebral vessels and late diffuse meningovascular syphilis are now the main forms of late neurosyphilis. With syphilis of the brain vessels, the membranes and substance of the brain are not involved in the process, so the composition of the cerebrospinal fluid remains normal. The disease is more common in patients aged 30-50 years. It is characterized by the development of a specific infiltrate in the vessels of the brain, which leads to thrombosis or stroke. The difficulty of diagnosis lies in the fact that in 60-70% of cases standard serological tests are negative. Depending on the location of the affected vessels, neurological symptoms vary. Thus, mental and sensitivity disorders, epileptiform seizures, and aphasia may occur. Occasionally, acute development of the disease is observed. At the same time, in some patients, intelligence gradually or sharply decreases, euphoria, carelessness or anxiety, hypochondria and tearfulness occur, the critical onset decreases, which, taken together, resembles a simple form of progressive paralysis (syphilitic pseudoparalysis). Delusions (syphilitic paranoid) or hallucinations (Plaut's syphilitic hallucinosis) are extremely rarely observed, which are more often observed as a mixed form. In these cases, a progressive development of the disease is noted. Meanwhile, the pace of development and severity of the disease are highly variable. Dementia occurs extremely rarely, while personality psychopathization or degradation is observed more often. Some patients develop “overvalued” ideas of a hypochondriacal or litigious nature; in these cases, asthenic disorders recede into the background.

Syphilis of the cerebral vessels is sometimes combined with other forms of neurosyphilis, for example, tabes dorsalis, with visceral syphilis, which facilitates diagnosis; often accompanied by atherosclerosis (more often in old age), and it is difficult to make a diagnosis. Sometimes cerebral syphilis can be diagnosed only after a trial of antisyphilitic treatment.

Tabesdorsalis(tabes) 50-70 years ago it was the main clinical form of late neurosyphilis. Currently, priority is given to vascular forms of late neurosyphilis. For the diagnosis of the disease, the following clinical symptoms are of great importance: pupillary disorders (miosis, mydriasis, anisocoria and especially the pathognomonic Argyll-Robertson syndrome), loss of knee and Achilles reflexes, staggering in the Romberg position, bone-air dissociation, trophic disorders, cold hyperesthesia in the area back, painful hypoesthesia in the chest area (in the Hitzig area). Nowadays, tabetic atropathies and primary atrophy of the optic nerves are rarely observed, there are often no subjective signs (tabetic pain, crises, paresthesia), dysfunction of the pelvic organs is not observed or is mild, so such patients rarely consult a doctor on their own. As a rule, they are detected by chance during an examination by a neurologist, during a hospital stay for another disease. The difficulty of diagnosis lies in the fact that now more than 70-80% of patients with tabes dorsalis have no history of early syphilis in the past, and in 40% of patients the standard serological complex is negative. Important diagnostic signs of tabes dorsalis are the presence of cardiovascular syphilis in 12-15% of patients, which appears in the initial period of the disease.

With tabes dorsalis, processes of proliferation and destruction occur in parallel in the posterior cords and posterior columns of the spinal cord. Therefore, some symptoms associated with proliferative processes may undergo regression if treatment is started in a timely manner. The changes resulting from destruction are irreversible.
Thus, with favorable treatment results in a patient with tabes dorsalis, pain decreases or disappears, gait improves, urination and defecation are normalized, cranial nerve paresis disappears, tendon reflexes and superficial sensitivity are normalized, bone conduction increases, and the condition is stabilized. Argyll-Robertson syndrome, absence of the knee and Achilles reflexes, tabetic arthropathy and optic atrophy are irreversible and remain even with effective treatment.
In 50% of patients with tabes dorsalis, the cerebrospinal fluid is within normal limits. With pathological changes, a slight increase in the amount of protein (up to 0.45-0.55%), an increase in the number of lymphocytes (20-30 per 1 mm3), positive globulin reactions (+++ or ++++) and the Wasserman reaction are noted ; Lange's reaction has the character of a paralytic curve (6654321100) or (less often) a “syphilitic wave” (2245332210).

Progressive paralysis can manifest itself 15-20 and even 40 years after infection, mainly in people who have received insufficient or no treatment for early forms of syphilis. In recent decades, patients with progressive paralysis, as well as patients with tabes dorsalis, as a rule, have no history of syphilis in the past, or information about the presence of skin rashes that could be assessed as syphilitic.
The development of progressive paralysis is based on damage to the substance of the cerebrum, more often in the area of the anterior lobe cortex, which occurs in connection with inflammatory changes in small vessels, mainly capillaries. However, the process sometimes extends to the cerebellum, the central gray nucleus. Significant degenerative changes lead to atrophy of entire cellular layers, mainly in the cerebral cortex, which is expressed in the thinning of the brain convolutions.
In the acute period of the disease, personality disintegration, pronounced progressive dementia, various forms of delusions, hallucinations, cachexia, etc. are noted. In the phase of complete development of the process, four forms of progressive paralysis are distinguished: cement, expansive, agitated and depressive.
In the demented form, the patient loses interest in his surroundings, apathy, dullness quickly set in, and then progressive dementia, which may be accompanied by general paralysis and weight loss. The expansive form is characterized by euphoria, against the background of which delusions of grandeur (megalomania), constant psychomotor activity with gradual progression of mental collapse develop. The clinical picture is very close to the expansive agitated form, in which excitement also predominates. However, patients with an agitated form of progressive paralysis can become unexpectedly dangerous to others, as they develop a tendency to destruction. Depression, anxiety, and hypochondriacal delirium are characteristic of the depressive form of progressive paralysis.
In recent decades, the clinical picture of progressive paralysis has been dominated by the dementia form with progressive dementia, inadequacy of criticism, apathy, and complacency.
It is important to determine the initial stage of progressive paralysis, in which there is a change in the patient’s personality (character), disturbances in memory, counting, writing and speech. These changes appear suddenly, against the background of complete health. The diagnosis is confirmed by positive standard serological reactions (in 95-98% of cases), positive RIBT and RIF (in 90-94% of cases) and changes in the cerebrospinal fluid (in 100% of cases): when performing the Lange test, a characteristic paralytic curve is obtained (6665432110).
If the patient has symptoms of progressive paralysis and tabes dorsalis, a diagnosis of tabolaralis is made.

Gumma of the brain or spinal cord is now rare. It is usually localized on the convex surface or at the base of the cerebral hemispheres. The neurological picture is characterized by focal symptoms, combined with headache and increased intracranial pressure. With gumma of the spinal cord, symptoms of its complete transverse lesion may develop. In the cerebrospinal fluid, protein-cell dissociation is observed (increased protein content with a low level of lymphocytes), positive Wasserman reactions, RIBT and RIF (the latter are also positive in the blood serum). Differentiate between gumma and brain tumor.
The best prevention of late forms of neurosyphilis is full treatment of early forms of syphilis, as well as examination of cerebrospinal fluid, carried out after the end of therapy (not earlier than a year later) or when patients are removed from the register. Cerebrospinal fluid should be examined in all patients with clinically significant symptoms of neurosyphilis for the purpose of diagnosis and to determine the quality of treatment.
Syphilis of the peripheral nervous system exists in two forms - mononeuritis and multiple lesions of nerves and roots - polyneuritis and polyradiculoneuritis. With mononeuritis, the ulnar, sciatic and peroneal nerves are usually affected. The clinical picture of syphilitic mononeuritis is often identical to the signs of other infectious nonspecific neuritis.
The most common clinical manifestations of mononeuritis include pain that is localized in the area innervated by this nerve. In most cases, they occur when the trigeminal nerve is damaged. Neuralgia of the sciatic nerve, intercostal nerves and paralysis of the nervus peroneus are relatively common.
With deeper lesions, zones of sensitivity disorders are determined, up to its complete disappearance.
From a clinical point of view, syphilitic polyneuritis is divided into acute and subacute. Both of these forms occur in the secondary period of syphilis and very rarely in the tertiary period. Clinically, patients with syphilitic polyneuritis have signs of sensory and motor disorders that are caused by multiple lesions of peripheral nerves.
Functional nervous and mental phenomena in syphilis. At
In certain lesions of the nervous system with syphilis, there are various symptom complexes that are expressed only functionally. These include neurasthenia and some psychoses.

Neurasthenia. Mental trauma from infection with syphilis almost always affects the mental state of patients. Neurasthenic mental disorders are varied and have individual manifestations. Therefore, the attending physician needs to be especially attentive and careful when communicating this diagnosis to the patient.

Syphilophobia. Its manifestations are partly similar to neurasthenia. One of the types of fixed psychopathy. Occurs in people who do not have syphilis. This disease is characterized by a variety of complaints. Unlike neurasthenia, patients with syphilophobia constantly experience fear that they have become infected with syphilis, and constantly go from one doctor to another. Such patients present difficulties in examination and treatment (as with other forms of phobias) and should be monitored by a psychiatrist. Sometimes such cases may be of differential diagnostic interest in relation to certain forms of neurosyphilis.
Other psychoses with acquired or congenital syphilis, they can occur in the form of manic-depressive states or phenomena of catatonia, Korsakoff's syndrome, etc. Such conditions indicate their direct connection with syphilitic infection.

Diagnostics
To establish a diagnosis, special anamnesis data, data from an objective examination of the patient, laboratory analysis for the detection of pathogens in erosive-ulcerative, papular elements in the genital area, oral cavity, and punctate from regional lymph nodes are important; serological tests of blood, cerebrospinal fluid, as well as modern diagnostic methods - PCR and IHC method.

Rice. Famous people with neurosyphilis

Neurosyphilis is a disease that seems to be responsible for the madness of such historical figures as Friedrich Nietzsche, Vladimir Ilyich Lenin, Al Capone

Despite the development of modern medicine, some patients seek medical help quite late. This is why HIV infection turns into AIDS, and ordinary syphilis affects the nervous system.

Compared to the middle of the last century, the number of patients with neurosyphilis has decreased significantly, but still, patients with this disease are found in the practice of modern doctors.

And the clinical picture of syphilis in the nervous system has changed somewhat. Increasingly, neurosyphilis manifests itself with few symptoms, this is associated with the development of atypical erased forms.

What is syphilis of the nervous system?

Syphilis of the nervous system is an infectious disease caused by a bacterium called Treponema pallidum. Its development is associated with the penetration of the pathogen into the human central nervous system.

Friedrich Nietzsche, Vladimir Lenin, Al Capone - they suffered from neurosyphilis

Development mechanism

There are 2 ways for bacteria to penetrate the medulla: hematogenous and lymphogenous. The lymphogenous route is the main one; the pathogen penetrates into the spinal substrate through the hematogenous route when the blood-brain barrier is weakened.

Treponema pallidum first affects the vessels and membranes of not only the brain, but also the spinal cord. As a result, an inflammatory process begins in them with the release of exudate. Scar changes form in the tissues of the meninges.

Over time, the mesenchyme loses its ability to kill Treponema pallidum, and the causative agent of syphilis penetrates directly into the parenchyma of the central nervous system.

This occurs approximately 5 years after the onset of the disease, in later stages. The bacterium invades nerve cells and fibers, causing degenerative changes in them. The advanced form of the disease is characterized by multifocal lesions of the central nervous system.

Causes

Most often, the disease occurs due to lack of treatment for the underlying disease. Insufficient treatment of syphilis or a complete lack of treatment leads to the fact that the bacterium begins to penetrate the nervous system.

Presumably, provoking factors for the development of the disease can be: weakening of the blood-brain barrier, frequent stress, injury, weakened immunity.

However, at present it is not known for certain why neurosyphilis develops in some patients with the same initial data, while others do not, and for what reason the symptoms of the disease and the clinical picture of the disease differ in patients.

Classification of the disease

There are several stages of disease development: early and late. Early neurosyphilis develops within 3-4 years after infection. However, the symptoms of early syphilis vary depending on the form of the disease.

Forms of early syphilis:

Late neurosyphilis can manifest itself in the form of meningovascular syphilis, and also as:

Optic nerve atrophy as an independent form of the disease. This pathology can lead to complete blindness or permanent vision impairment.
Gummous syphilis, which causes paralysis of the lower extremities, increased ICP.
Progressive paralysis. This disease begins with deterioration of memory and attention, and mood swings. Then psychiatric pathologies are “connected” to the existing symptoms: hallucinations, delusions, as well as neurological symptoms, including tongue tremor. This form of the disease leads to death, which occurs literally a few months after the first signs of the disease appear.
, which is characterized by short-term pain in the legs, impaired sensitivity of the limbs, ataxia, and also leads to a change in gait.

Among the above forms, congenital syphilis stands apart. Currently, it is diagnosed quite rarely, since most pregnant women are tested for syphilis during pregnancy.

Difficulties in diagnosis

If syphilis is suspected, and if there are neurological symptoms of unknown etiology, the doctor may send the patient for further examination. CT scans are used as auxiliary research methods and they can reveal brain atrophy, the presence of gummas,. It would also be useful to consult an ophthalmologist with an examination of the fundus.

Specific research methods aimed at diagnosing neurosyphilis are blood and cerebrospinal fluid tests, treponemal and non-treponemal tests with blood serum and cerebrospinal fluid. Specific treponemal tests are more accurate than non-treponemal tests, which can give false results.

With syphilis, an increased protein content and some other pathological reactions are detected in the cerebrospinal fluid.

Treatment methods

The goal of treatment is to destroy the bacteria that caused syphilis, normalize the patient’s condition, regress negative neurological symptoms, and reduce the epidemiological danger of the patient in relation to healthy people.

During therapy, methods are used aimed at destroying the causative agent of the disease, and auxiliary medications and vitamins are also prescribed. The greatest difficulty is in the treatment of advanced forms of the disease. Sometimes they require long-term treatment and several courses of medications.

Patients are prescribed:

For tabes dorsalis, limb massage, Frenkel gymnastics, and electrophoresis are indicated.

Possible complications

Advanced forms of neurosyphilis are difficult to treat, even with large doses of antibiotics. If the disease is detected at an early stage of development, the prognosis is favorable.

Progressive paralysis cannot be cured, and meningovascular syphilis can cause it. Sometimes syphilis of the nervous system, even after recovery from it, leads to irreversible consequences.

These may include paresis of the limbs, blurred speech, and atrophy of the optic nerve can lead to decreased vision and even blindness. With tabes dorsalis, the prognosis for life is favorable, but treatment does not lead to regression of symptoms.

Neurosyphilis, namely its complications and consequences, often cause disability.

Prevention of violation

The only method of preventing the disease is timely and high-quality treatment of early forms of syphilis. If neurological symptoms of the disease occur, you should consult a doctor as soon as possible.

Neurosyphilis is a formidable and dangerous disease that, in the absence of adequate treatment, can lead to serious consequences and even cause death. That is why the patient must approach the treatment of the disease with full responsibility.

Syphilis is a sexually transmitted disease that disrupts the functioning of certain internal organ systems. In the absence of proper treatment, after a short period of time, neurosyphilis may develop, characterized by the penetration of infection into the nervous system. This is a very dangerous pathology 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 caused by the penetration of the syphilis pathogen into the body. The infection can involve all parts of the nervous system in the pathological process, starting with the brain and ending with the sensory organs. Clinically, the disease is manifested by a number of neurological disorders: dizziness, muscle weakness, paralysis, convulsions, dementia.

People first started talking about syphilis in the Middle Ages. In those days, alchemists did not yet know what neurosyphilis was. Participants in the Crusades suffered from the disease. During the Hundred Years' War, syphilis was otherwise called the French disease, since the British “brought” it from the mainland. Several decades ago, syphilis was considered a death sentence for those infected. Thanks to the rapid development of science, this disease can now be cured in a few weeks. However, advanced forms often cause death. The high mortality rate 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. Narrow-spectrum antibiotics are usually used for treatment. Today, the disease neurosyphilis is much less common than in the last century. This is due to improved quality of diagnostic measures, preventive examinations of the population, and early therapy.

Main causes of infection

The causative agent of neurosyphilis is the bacterium Treponema pallidum. Infection occurs directly from a sick person. As a rule, this happens during unprotected sexual intercourse. A pathogenic microorganism enters the human body through damage to the mucous membranes or skin. The infection then spreads through the bloodstream.

The body responds to foreign bacteria by producing antibodies. When the blood-brain barrier is reduced, Treponema pallidum invades the nervous system. Thus, neurosyphilis gradually develops.

The causes of this pathology may also be nonspecific. The development of the disease is facilitated by untimely treatment of early forms of the disease, emotional distress, decreased immunity, traumatic brain injury, and mental fatigue.

The main routes of infection:

Sexual. This is the most common mode of transmission of infection. The pathogen penetrates through mucous membranes and microdamages on the skin. The type of sexual contact usually does not play a special role. The use of barrier contraceptives (condoms) reduces the risk of infection, but does not reduce it to zero.
Blood transfusion(during blood transfusion, dental procedures).
Domestic. Infection through household means requires very close contact with a sick person. Transmission through towels, shared household items, or the use of the same razor or brush cannot be ruled out.
Transplacental(transmission from mother directly to fetus).
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, and autopsies.

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

Clinical picture

Signs of neurosyphilis can be pronounced or faded when the disease is at the initial stage of development. Doctors include periodic headaches, fatigue, and numbness of the extremities as common symptoms characteristic of the disease.

Experts distinguish between early, late and congenital variants of the disease. The first develops over several years from the moment of infection. Otherwise, it is called mesenchymal, since the vessels and membranes of the brain are primarily involved in the pathological process. The late form of pathology manifests itself approximately five years after the penetration of Treponema pallidum 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 the 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 blood vessels of the brain. Its main manifestations include syphilitic meningitis, meningovascular syphilis and latent neurosyphilis. We will consider the symptoms and characteristic features of each form in more detail below.

Late neurosyphilis

This pathology is also divided into several forms:

Progressive paralysis.
Tabes dorsalis.
Gummy neurosyphilis.
Optic nerve atrophy.
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 Treponema pallidum into brain cells with their subsequent destruction. Initially, patients show changes in higher nervous activity (deterioration of attention and memory, irritability). As the disease progresses, mental disorders (depression, delusions and hallucinations) appear. Neurological symptoms include tongue tremor, dysarthria and changes in handwriting. The disease develops rapidly and is fatal within a few months.

When the dorsal roots and cords of the spinal cord are affected, doctors talk about tabes dorsalis. Clinically, the pathology manifests itself in the form of loss of Achilles reflexes and instability. As a result, a person’s gait changes. The occurrence of optic nerve atrophy cannot be ruled out. Another characteristic feature of the disease are trophic ulcers.

Atrophy in some cases acts as an independent form of a disease such as neurosyphilis. The consequences of the disease significantly reduce a person’s quality of life. Initially, the pathological process affects only one eye, but after some time it becomes bilateral. Visual acuity decreases. In the absence of timely treatment, complete blindness develops.

Gummy neurosyphilis. Gummas are round formations that form as a result of inflammation caused by treponema. They affect the brain and spinal cord, compressing 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 is repeatedly examined to detect infections. If intrauterine infection has occurred, it is very easy to recognize. The clinical picture is characterized by the same symptoms as in adult patients, with the exception of tabes dorsalis.

The congenital form of the disease has its own distinctive symptoms. These are 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

We have already explained what neurosyphilis is. How to confirm this disease? Making a final diagnosis is possible taking into account three main criteria: a characteristic clinical picture, test results for syphilis, and identification 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 comprehensively. In some cases, multiple repetitions of tests are required. The most informative methods of laboratory diagnostics include RPR analysis, RIBT, RIF, as well as identification of the infectious agent in the contents of affected skin areas.

In the absence of pronounced symptoms, it is carried out. In case of neurosyphilis, an increased level of protein and the causative agent of the disease - Treponema pallidum - is found in the cerebrospinal fluid.

MRI and CT of the spinal cord are prescribed to all patients with suspected neurosyphilis. Diagnostics using special devices allows us to identify hydrocephalus and atrophy of the brain matter.

How to overcome neurosyphilis?

Treatment of early forms of the disease is based on aggressive antibacterial therapy. For this purpose, penicillin and cephalosporin drugs are used. As a rule, therapy is complex and involves the use of several medications simultaneously. The usual regimen: Penicillin, Probenecid, Ceftriaxone. All medications are administered intravenously. Penicillin injections are also given into the spinal canal. The course of treatment usually lasts two weeks. After this, the patient undergoes a second examination, the results of which can be used to judge whether neurosyphilis was defeated. Treatment is extended if Treponema pallidum is detected in the cerebrospinal fluid.

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

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

Forecast and consequences

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

Late forms of pathology do not respond well to drug therapy. Neurological symptoms usually remain with the patient for life.

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

Photos of patients with this diagnosis and after a course of treatment make it possible to understand the 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 abstaining from uncontrolled sexual intercourse. You should pay special attention to personal hygiene. People infected with Treponema pallidum must undergo preventive examinations by a neurologist.

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, you should not neglect the prevention of the disease, and after infection, immediately seek help from a doctor.