One Night with Venus, a Lifetime with Mars

Abstract

Neurosyphilis complicates approximately one third of untreated cases of syphilis. Neurosyphilis is an imprecise term denoting any presence of syphilis in the CNS and subsumes syphilitic meningitis, meningovascular syphilis, parenchymatous syphilis and gummatous syphilis. Of these, meningovascular syphilis is most commonly associated with large vessel arteritis and stroke, particularly of the middle cerebral artery. Although syphilis rates have increased since the latter part of the twentieth century, neurosyphilis remains a rare disease and epidemiological estimates are marred by imprecise use of terminology and the complexity of interpreting common laboratory tests.

Neurosyphilis can present in myriad ways depending on the extent of meningeal and vascular involvement. Meningovascular syphilis has no characteristic features on CT and MRI; radiologically, syphilitic arteritis most frequently involves the middle cerebral artery, but may include any intracranial vessels. Testing uses highly sensitive, but non-specific treponemal tests, followed by highly specific, but insensitive non-treponemal tests. Investigation must be thoughtful if improper use and interpretation of tests is to be avoided. The rising incidence of syphilis in recent decades warrants its consideration in the differential diagnosis of atypical stroke, particularly as early treatment with penicillin is effective.