In addition to the risk of overlooking the disease on account of its rarity, we nowadays face the additional problem that neurosyphilis can occur in atypical or attenuated forms. This may be due in large measure to unwitting practical suppression of the infection in the earlier stages by antibiotics given for other purpose. Thus while fully developed examples of general paresis and tabes dorsalis have become rare, modified forms of neurosyphilis with atypical presentation and relatively minor symptomatology are increasingly encountered. In a series of 241 patients, almost half presented with unrelated symptoms, the diagnosis being made by routine investigation after suspicion had been aroused by neurological or ocular findings7 In a quarter the presentation was with focal or generalized seizures. Twelve percent presented with declining vision or other ophthalmological features, and 11% with confusion following a cerebrovascular accident. Only 5% had the full clinical picture of general paresis. Therefore, it is important for all clinicians to keep neurosyphilis in mind, look carefully for the cardinal signs in the pupillary reactions and tendon reflexes and to check regularly with serological tests.
Abdul Khalid, Shishir K. Regmi, M. Nepal
Journal name not available for this finding