CEREBROVASCULAR COMPLICATIONS OF NEUROSYPHILIS - THE RETURN OF AN OLDPROBLEM

Neurosyphilis is increasing due to a rise in the number of cases of sy philis in cocaine/crack addicts and in patients with HIV infection. Ne urosyphilis is an example of a unique group of chronic CNS diseases th at may cause either a degenerative or a vasculitic process, where the main pathogenic event is 'end-arteritis obliterans' of terminal arteri oles. In meningovascular neurosyphilis, the most commonly involved art ery is the middle cerebral artery. It generally presents with a prodro mic phase, weeks or months before the onset of identifiable vascular s yndromes. When there is focal inflammation the clinical picture is cha racterized by hemiplegia, whereas in the case of multifocal involvemen t of small intracranial arteries, it presents with a slowly progressiv e loss of cognitive functioning and personality changes. Since neurolo gical deficits once established may only slightly improve with treatme nt, the goal of therapy is to halt the progression of the disease. Int ravenous aqueous crystallin penicillin G is the most accepted treatmen t. HIV-infected patients have shown accelerated development of neurosy philis, and it is suggested that coinfection with HIV alters the cours e of Treponema pallidum infection. Atypical manifestations of neurosyp hilis have been reported among HIV patients, including fulminant prese ntation, rapid progression, atypical serological findings, and failure of conventional doses of penicillin to eradicate infection.