More sensitive and specific markers for neurosyphilis have been investigated. Angiographically, there is hyperfluorescence in the area of the perineuritic lesion, often with scattered focal hypofluorescence(leopardspotting). A particular condition-acute syphilitic posterior placoid chorioretinitis (ASPPC)-distinct from ocular syphilis has been reported. Bilateral tonic pupils have been noted, with light-near dissociation and denervation hypersensitivity. Adhesions of the iris to the anterior lens (synechiae) may be present, which may produce a fixed pupil this should not be confused with Argyll Robertson pupil. This is a relatively common manifestation of late syphilis. All symptoms can resolve with typical treatment of neurosyphilis, namely, intramuscular procaine penicillin-G.
Symptoms of photophobia and dimming of vision obviously could develop. often includes anterior uveitis or panuveitis (granulomatous or nongranulomatous), retinitis, retinal vasculitis, vitreitis, and papillitis. Persons not treated for persistent CSF abnormalities are at risk of developing clinically apparent disease and are hereafter referred to as having contracted neurosyphilis. The pathogenesis of neurosyphilis is similar to that in the rest of the body.
Neurosyphilis, quite directly, is defined as a CSF WBC count of 20 cells/µL or greater or a reactive CSF Venereal Disease Research Laboratory (VDRL) test result. This fact leads clinicians to heighten their degree of suspicion, being profoundly alert to the possibility of this infection within the HIV populations. Of late, there has been a drastic increase, worldwide, in the incidence of syphilis, especially in urban areas. Invasion of the CNS occurs early in the course of untreated syphilis. Syphilitic infection of the nervous system results in the most chronic, insidious meningeal inflammatory process known. Syphilis is a sexually transmitted disease caused by Treponema pallidum, with human beings as the only host.
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