Yesterday we talked about a pt with strange white matter lesions. The resident had – of course – done a spinal tap, discovered oligoclonal bands. When discussing various microbiology tests we were still missing, it dawned on me: she hadn’t even done a syphilis serology. What used to be routine on all neuro pts has gotten kicked so far back that we tend to forget this great chameleon of all neurological complaints.

So first of all: the HBL rule – allways do HIV, Borreliosis, Lues (aka Syphilis) whenever thinking about infectious diseases in Neuro.

Here is a list of contexts, in which to think of Syphilis:

– Stroke in the (relatively) young
– “Viral meningitis” perhaps with elevated CSF pressure
– Gradual vision loss
– Vertigo with non-typical presentation
– (pre-)dementia
– Psychosis, particularly mania, not only because general paresis can look like BPD, but also b/c the sexual generosity of mania can certainly to STDs.
– Ataxia (of course)
– Myelitis
– Any other neuro complaint

Tomorrow we will be covering Neurosyphilis, using standard textbook chapters (Adams), the current AWMF guideline and the article

The changing face of neurosyphilis.Chahine LM, Khoriaty RN, Tomford WJ, Hussain MS.
Int J Stroke. 2011 Apr;6(2):136-43. doi: 10.1111/j.1747-4949.2010.00568.x. Epub 2011 Jan 10.

While surfing on the Syphilis wave, I came across a book title, that should find it’s way into my shelf: Deborah Hayden, POX (here‘s a review in the BMJ).


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