Patients with neurosyphilis may have a positive history of unprotected sexual activity, HIV infection, chemotherapy, substance abuse and positive history of long-term untreated syphilis disease. Common symptoms of based on the classification include diplopia, hearing loss, hoarseness, headache, dizziness, vertigo, nausea, photophobia, lightning pains, impaired sensation and proprioception, hypesthesias, hemiparesis, homonymous hemianopsia, slurred speech and dysarthria. Less common symptoms of neurosyphilis include psychosis, depression, mania and cranial nerve abnormalities especially the optic nerve, facial nerve, and the vestibulocochlear nerve.

Patients with neurosyphilis may have a positive history of:

• Unprotected sexual activity
• HIV infection
• Immunosuppressive therapy
• Substance abuse
• Positive history of long-term untreated syphilis disease^[1]

The symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis. Common symptoms of based on the classification include:

• Cranial nerve dysfunction symptoms:
  • Diplopia^[2]
  • Impaired vision^[3]
  • Hearing loss^[4]
  • Hoarseness^[5]

• Meningitis symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):^[1][6][7][8]
  • Headache
  • Dizziness
  • Vertigo
  • Nausea and vomiting
  • Photophobia
• Symptoms of spinal cord involvement (tabes dorsalis):
  • Lightning pains^[9]
  • Impaired sensation and proprioception^[10]
  • Hypesthesias^[11]
• Symptoms of cerebral syphilitic gumma:^[12][13][14]
  • Hemiparesis
  • Homonymous hemianopsia
  • Slurred speech
  • Dysarthria

The symptoms of tabes dorsalis typically occurs 10 to 30 years after primary infection by treponema pallidum.^[15]

Less common symptoms of neurosyphilis include:^[16][17]

• Psychosis
• Depression
• Mania
• Cranial nerve abnormalities especially the optic nerve, facial nerve, and the vestibulocochlear nerve.