DEMENTIA PARALYTICA IN A 15-YEAR-OLD BOY

A 15-year-old boy, whose history revealed an unremarkable pregnancy, b irth and neonatal period and who had shown a normal motor and mental d evelopment, presented at the hospital with deterioration of cognitive functions since the age of 7. He was bedridden with manifest ataxia in volving all limbs, anisocoria and a sluggish to absent pupil reaction to light. Syphilis serology was positive with a Venereal Disease Resea rch Laboratory (VDRL) titer of 1:256 and a Treponema pallidum Haemaggl utination Assay (TPHA) titer of 1:163840. Cerebrospinal fluid (CSF) pr otein concentration was 55 mg/dl and CSF-leucocyte count was 14/mm(3) (85% mononuclear cells). CSF-VDRL-titer was 1:16. A diagnosis of conge nitally acquired dementia paralytica was made, since the boy's parents ' clinical exam and serology results were suggestive for latent syphil is. Although cognition was still very much deteriorated five months fo llowing penicillin treatment, clinical examination revealed partial re cuperation. Screening for syphilis should be part of routine resting i n every subject presenting with cognitive deterioration, regardless of age.