Neurosyphilis develops when the pathogen penetrates into the central nervous system, which occurs more often in the third stage of the disease syphilis (tertiary syphilis) in patients who have not received treatment.
Brain syphilis, or neurosyphilis, is an infectious lesion of the central nervous system caused by the pathogen Treponema pallidum (pale treponema).
Pale treponema refers to the order of Spirochaetales, which includes the leptospirosis (Leptospira), epidemic swirling typhus (Borelia recurentis), and the diseases of Lime (Borelia burgdorferi). Some representatives of treponemus are found in normal human microflora and are not pathogenic.
Infection occurs in the course of sexual contact with the patient (which has syphilids of the skin and mucous membranes, broad warts, solid chancre), much less frequently in blood transfusions and transplacental pathway.
Types and manifestations of neurosyphilis
The clinic is allocated asymptomatic and clinically apparent neurosyphilis. A diagnosis of "asymptomatic neurosyphilis" poses, if there is no neurological disorders, there is no clinical picture of primary and secondary syphilis, but pathological changes in the cerebrospinal fluid are detected.
It should be noted that 40% of patients with primary and secondary syphilis find changes in liquor, in such cases, it is also possible to assume asymptomatic neurosyphilis. Clinically apparent neurosyphilis may manifest in meningeal, meningovascular, parenchymal and mixed lesions.
In syphilitic meningitis, the dorsal and/or cerebellar shells are affected, headache, nausea, vomiting, cranial nerves are affected, mental disorders and epileptic seizures occur.
Meningovascular syphilis is mostly affected by small, medium, large arteries of the brain, so the disease is manifested as an ischemic or hemorrhagic stroke on the background of a previous encephalitis or a specific cerebral vasculitis.
In the case of parenchymal syphilitic lesions development of either progressive paralysis or spinal dryness is possible. Progressive paralysis, caused by a large defeat of the substance of the brain, manifests itself in changes in personality, intelligence, disturbances of perception and speech, eye damage, affective disorders.
Spinal dryness is due to demyenilization of the spinal ganglia, the posterior roots and the spinal cord's spinal cords. Violations in pain relief can lead to the development of trophic ulcers.
How to detect neurosyphilis
Two groups of methods are used for diagnostics: nonreponeous reactions and treponemal reactions.
The former include, for example, the reaction of precipitation of inactivated serum or native serum or plasma with scardyliopinovy antigen. Specific treponemal reactions include reactions of immunofluorescence-absorption, micro-modification of indirect hemagglutination reactions, immobilization reaction with treponemus (most precise, but extremely labor-intensive).
For the treatment of neurosyphilis using penicillins using special schemes. The control of the liquor allows us to assess the dynamics and quality of treatment. Except for cases of spinal dryness (now it is a fairly rare form), all other types of neurosyphilis respond well to penicillin treatment. When allergies to penicillins are selected other drugs, such as ceftriaxone.