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Neurosyphilis and neuro-AIDS 

Neurosyphilis and neuro-AIDS

Neurosyphilis and neuro-AIDS

Hadi Manji

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date: 28 April 2017


Invasion of the central nervous system occurs early in the course of syphilis infection. Neurosyphilis causes meningitis, myeloradiculopathy due to pachymeningitis, and gummatous cord and brain lesions; endarteritis may cause infarction.

Clinical features—these are protean: neurosyphilis should always be considered in the diagnosis of neurological disorders without a convincing explanation, including (1) stroke—especially in young patients; (2) ocular abnormalities—e.g. optic neuritis, choroidoretinitis, pupillary abnormalities; (3) unexplained cranial nerve disease, including sensorineural deafness and vertigo; (4) dementia—low-grade meningo-encephalitis is associated with generalized changes in the brain and occasionally with frontotemporal dementia; (5) tabes dorsalis—a sensory ataxia caused by disease of the dorsal roots, ganglia and posterior columns.

Diagnosis, treatment, and prognosis—diagnosis requires specific serological tests and examination of the cerebrospinal fluid (see Chapter 7.6.36). Treatment with antimicrobials is often curative in patients with meningitic or meningovascular disease, but is only partially effective in those with late forms of dementia or tabes. Follow-up after treatment should include repeat examinations of the cerebrospinal fluid until the cell count is restored to normal limits.

Neurological complications of HIV infection

The neurological sequel of HIV infection include (1) opportunistic infections—e.g. cryptococcal meningitis; toxoplasma encephalitis; tuberculous meningitis and tuberculomata; cytomegalovirus encephalitis, cauda equina syndrome; vasculitic neuropathy; progressive multifocal leucoencephalopathy (PML) and (2) neoplasms—e.g. primary CNS lymphoma.

HIV itself also affects the central and peripheral nervous systems causing HIV associated neurocognitive syndromes including dementia, vacuolar myelopathy and peripheral neuropathy.

The introduction of highly active antiretroviral therapies has greatly reduced the frequency of all such problems in patients with access to treatment. However, newer complications are now increasingly recognized—e.g. immune reconstitution inflammatory syndrome (IRIS).

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