Symptomatic neurosyphilis most often presents with posterior column lesions, the hallmark of tabes dorsalis, typically fifteen to twenty-five years after primary infection. Neurosyphilis may be asymptomatic with abnormal cerebrospinal fluid (CSF) but no neurological symptoms or signs. 3 The Argyll Robertson (AR) pupil (Fig 1) is an important, classical sign of neurosyphilis. Tertiary syphilis includes not only neurosyphilis but also gummata, cardiovascular, and meningovascular varieties. Historically, neurosyphilis was so common that Kinnier Wilson in his unique textbook Neurology in 1940 devoted over one hundred pages to it. Because we now have effective antibiotic treatment, both clinical clues and screening tests are of vital importance, especially in early and in asymptomatic latent cases. ![]() 2 A clinical diagnosis of syphilis is no longer the occasional curiosity it was at the end of the twentieth century, yet routine screening tests have fallen into disuse. 1 In 2020, 133,945 cases of all stages of syphilis were reported in the US, and in the UK the rate of newly diagnosed cases in 2020 was twice that in 2012. Since reaching a historic low in 2000 and 2001, the incidence of syphilis has increased almost every year. Several direct and serological tests of varying sensitivity and specificity have now replaced the WR. In my student days, the Wasserman reaction (WR), though not specific, was performed almost routinely in patients on medical wards to detect syphilis. StatPearls andQuillen College of Medicine, East Tennessee State University are Equal Opportunity/Affirmative Action/Equal Access Institutions.Douglas Argyll Robertson and his pupils November 8, 2022įigure 1.StatPearls andQuillen College of Medicine, East Tennessee State University will not be responsible for other expenses incurred by the participant in the unlikely event that the program is canceled. StatPearlsand and Quillen College of Medicine, East Tennessee State University reserve the right to cancel any course due to unforeseen circumstances.StatPearls specifically disclaims responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through a participant's misunderstanding of the content.Ĭancellation Policy: Cancellations must be received in writing and a money-back guarantee is provided if not completely satisfied. The information presented does not necessarily reflect the views of StatPearls or any commercial supporters of educational activities on. ![]() The information provided for this activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. Readers should verify all information before employing any therapies described in this educational activity.
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