Which disorders should be considered in the differential diagnoses of neurosyphilis?

Updated: Jul 17, 2018
  • Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

Given the protean manifestations of the various forms and stages of neurosyphilis, the differential diagnostic possibilities are broad.

If the presentation is that of cranial nerve palsy, other basal meningitides should be considered, such as tubercular involvement. Acute meningitis due to other organisms is also possible.

Meningovascular syphilis can manifest as a strokelike phenomenon, in which case all causes of vaso-occlusive or ischemic infarction must be reviewed.

If gummata are present, other space-occupying lesions are included in the differential diagnosis, such as primary or metastatic neoplasms with mass effect.

General paresis can manifest with a multitude of psychiatric symptoms, including delirium, dementia, mania, psychosis, personality change, and/or depression. [44]

Tabes dorsalis can appear consistent with subacute combined degeneration of the spinal cord. Multiple sclerosis must also always remain in the differential. The presence of an Argyll Robertson pupil indicates the possibility of the differential diagnosis mentioned under tabes dorsalis (see above).


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