Ardelean, Gavril - Buicu, Florin (szerk.): Satu Mare. Studii şi comunicări. Seria ştiinţele naturale 8. (2007)

Medicină

Satu Mare - Studii şi Comunicări Seria Ştiinţele NaturiiVo\. VIII (2007)

photophobia) 17% , urinary symptoms (e.g., bladder incontinence) 17%, lightning pains 10%, headache 10%, dizziness 10% , hearing loss 10%, seizures 7% [3].

Signs of neurosyphilis, in order of decreasing frequency, include the following hyporeflexia 50%, sensory impairment (e.g., decreased proprioception, loss of vibratory sense) 48%, pupillary changes (anisocoria, “Argyll Robertson pupils”) 43%, cranial neuropathy 36%, dementia, mania, or paranoia 35%, Romberg sign 24%, Charcot joint 13%, hypotonia 10%, optic atrophy 7% [3].

According to Merrit classification the neurosyphilis implies these seven types [4]: (a) asymptomatic, (b) cerebromeningeal, (c) cerebral-vascular, (d) spinal meningovascular, (e) parenchimatous, (f) focal gummatous and (g) atypical presentation forms. The asymptomatic type is characterized by abnormal findings in the CSF and has two fases: early (0-5 years) and late (over 5 years). The cerebromeningeal type implies meningitis and cranial nerve palsies; in the cerebral-vascular type hemiparesis, aphasia and seizures can be encountered. General paresis, tabes dorsalis, optic atrophy are representative for the parenchymatous form and cerebral or spinal compression for the

focal gummatous one. The atypical presentations include: tinnitus, deafness, dizziness, papillary changes, seizures, organic mental syndrome, pyramidal signs and other isolated or combined neurological abnormalities. j

Although the cases of neurosyphilis are rare these days, they are not exceptional. In diis case the patient eluded the epidemiologic network and developed symptoms that can be included in the cerebral-vascular type. The wife and daughter of the patient were investigated. The results showed that the wife had a positive serology (TPHA ++) as a sign of an old infection with T.paliidum. The daughter (3 years old) had a negative serology (VDRL - and TPHA-).

Conclusions

There is a need in strengthening of the public health component in the control and surveillance of STI and IIIV/AIDS. The legal framework of epidemiologists has to improve reporting and to target vulnerable groups in prevention activities. Neurosyphilis can be clinically manifest in various signs and symptoms and CSF tests should routinely include TPHA and VDRL. Penicillin G is the gold standard in treating neurosyphilis.

Figure no 1. Patient G.C. 38 years. Bilateral temporal parenchymatous lesions

Bibliography

1. Chivers C.J., “A retrospective diagnosis says that Lenin had syphilis”, The New York Times, USA, 2004

2. Fitzpatrik Thomas B.,’’Dermatology in general medicine”, Voi. II, Forth Fxlition, McGraw-Hill, Inc, 2721, table 218-2.

3. Knudsen Richard P, De Menezes Marcio Soteres, Neurosyphtlis, eMedicine, topic 684

4. Rowland, L.P. (Red.). (1989). Neurosyphilis. Meritt’s Textbook of Neurology. Philadelphia: Lea and Flebiger.

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