Neurosyphilis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]Tarek Nafee, M.D. [3]

Overview

Neurosyphilis must be differentiated from other diseases that cause abnormal gait, Blindness, confusion and depression, such as multiple sclerosis, Brain tumours, Wernicke’s encephalopathy, CNS abscess, electrolyte disturbance, Subdural empyema, subarachnoid hemorrhage, brain stroke, Conversion disorder and Drug toxicity.

Differentiating X from other Diseases

Neuroyphilis has an extensive differential diagnosis.

Neurosyphilis must be differentiated from other diseases that cause abnormal gait, Blindness, confusion and depression, such as multiple sclerosis, Brain tumours, Wernicke’s encephalopathy, CNS abscess, electrolyte disturbance, Subdural empyema, subarachnoid hemorrhage, brain stroke, Conversion disorder and Drug toxicity.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]

Diseases	Diagnostic tests				Physical Examination					Symptoms			Past medical history	Other Findings
Diseases	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Neck stiffness	Motor or Sensory deficit	Papilledema	Bulging fontanelle	Cranial nerves	Headache	Fever	Altered mental status	Past medical history	Other Findings
Neurosyphilis^[3]^[4]		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive^[5]	✔	✔	✔	✔	✔	✔	✔	✔	Unprotected sexual intercourse, STIs History of multiple sexual partners. History of genital ulcer (chancre)	Blindness confusion, epression, Abnormal gait
Multiple sclerosis			Oligoclonal bands of IgG on electrophoresis of cerebrospinal fluid	MRI	✔	✔			✔	✔		✔	History of fatigue Mood problems Spasticity Bowel and bladder dysfunction	Vision problems Balance problems Dizziness Areas of demyelination in CNS MRI
Brain tumour^[1]^[2]		✔	Cancer cells^[7]	MRI		✔	✔	✔	✔	✔		✔		Cachexia Gradual progression of symptoms
Wernicke’s encephalopathy			Normal				✔	✔			✔		History of alcohal abuse	Ophthalmoplegia confusion
CNS abscess		✔	↑ leukocytes >100,000/ul ↓ glucose and ↑ protien ↑ red blood cells lactic acid >500mg	Contrast enhanced MRI is more sensitive and specific Histopathological examination of brain tissue	✔	✔	✔		✔	✔	✔	✔	History of drug abuse endocarditis	High grade fever Fatigue Nausea vomiting
Electrolyte disturbance	↓ or ↑			Depends on the cause						✔		✔		Confusion Seizures
Subdural empyema		✔		Clinical assesment and MRI	✔	✔	✔	✔	✔			✔	History of relapses and remissions	Blurry vision urinary incontinence Fatigue
Delirium tremens		✔		Clinical diagnosis		✔	✔		✔	✔	✔	✔	Alcohol intake Sudden withdraw or reduction in consumption	Tachycardia diaphoresis hypertension tremors, mydriasis Positional Nystagmus,
Subarachnoid hemorrhage^[8]		✔	Xanthochromia^[9]	CT scan without contrast^[11]^[6]	✔	✔	✔	✔	✔	✔	✔	✔	Trauma/fall	Confusion dizziness Nausea Vomiting
Stroke		✔	Normal	CT scan without contrast		✔	✔		✔	✔		✔	TIAs, hypertension, diabetes mellitus	Speech difficulty Gait abnormality
Viral encephalitis		✔	Increased RBCS or xanthochromia Mononuclear lymphocytosis High protein content Normal glucose	Clinical assesment	✔	✔	✔		✔	✔	✔	✔	Tick bite Mosquito bite Viral prodome for several days	Extreme lethargy Rash hepatosplenomegaly lymphadenopathy behavioural changes
Herpes simplex encephalitis		✔		Clinical assesment			✔	✔	✔	✔	✔		History of hypertension	Delirium Cortical blindness cerebral edema seizure
Drug toxicity											✔	✔		Lithium Sedatives phenytoin carbamazepine
Conversion disorder				Diagnosis of exclusion		✔		✔		✔	✔	✔		Tremors blindness Difficulty swallowing
Febrile convulsion			Not performed in first simple febrile seizures	Clinical diagnosis and EEG					✔	✔	✔	✔	Family history of febrile seizures Family history of gastroenteritis Family history of viral illness or	Age > 1 month,
Hypoglycemia	↓ or ↑			Serum glucose HbA1c		✔				✔		✔	History of diabetes	Palpitations sweating dizziness Low serum glucose

References

↑ ^1.0 ^1.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
↑ ^2.0 ^2.1 Invalid <ref> tag; no text was provided for refs named pmid3883130
↑ ^3.0 ^3.1 Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). “Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients”. J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
↑ ^4.0 ^4.1 Berger JR, Dean D (2014). “Neurosyphilis”. Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ ^5.0 ^5.1 Ho EL, Marra CM (2012). “Treponemal tests for neurosyphilis–less accurate than what we thought?”. Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
↑ ^6.0 ^6.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). “ACR Appropriateness Criteria® on cerebrovascular disease”. J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
↑ ^7.0 ^7.1 Weston CL, Glantz MJ, Connor JR (2011). “Detection of cancer cells in the cerebrospinal fluid: current methods and future directions”. Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
↑ ^8.0 ^8.1 Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453
↑ ^9.0 ^9.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). “Cerebrospinal fluid in cerebral hemorrhage and infarction”. Stroke. 6 (6): 638–41. PMID 1198628.
↑ Goldenberg MM (2012). “Multiple sclerosis review”. P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.
↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). “Imaging in acute stroke”. West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

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[pmid1278192-1] 1.0 ^1.1 Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192

[pmid3883130-2] 2.0 ^2.1 Invalid <ref> tag; no text was provided for refs named pmid3883130

[pmid22482824-3] 3.0 ^3.1 Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). “Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients”. J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.

[pmid24365430-4] 4.0 ^4.1 Berger JR, Dean D (2014). “Neurosyphilis”. Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-5] 5.0 ^5.1 Ho EL, Marra CM (2012). “Treponemal tests for neurosyphilis–less accurate than what we thought?”. Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.

[pmid21807345-6] 6.0 ^6.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). “ACR Appropriateness Criteria® on cerebrovascular disease”. J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.

[pmid21371327-7] 7.0 ^7.1 Weston CL, Glantz MJ, Connor JR (2011). “Detection of cancer cells in the cerebrospinal fluid: current methods and future directions”. Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.

[pmid14585453-8] 8.0 ^8.1 Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453

[pmid1198628-9] 9.0 ^9.1 Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). “Cerebrospinal fluid in cerebral hemorrhage and infarction”. Stroke. 6 (6): 638–41. PMID 1198628.

[pmid22605909-10] Goldenberg MM (2012). “Multiple sclerosis review”. P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.

[pmid21694755-11] Birenbaum D, Bancroft LW, Felsberg GJ (2011). “Imaging in acute stroke”. West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

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Neurosyphilis differential diagnosis

Overview

Differentiating X from other Diseases

References

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