- Comes on 10-35 years after primary infection
- It is a neurological form of tertiary syphilis
- It is rare in the post-antibiotic era
- Neurosyphilis damage to dorsal (sensory) nerve roots and degeneration of the posterior columns (ataxia)
- General paralysis of the insane with a dementia type picture, cortical atrophy, delusions of grandeur famously and epilepsy
- Meningovascular syphilis produces an endarteritis and fibrosis affecting II, III and IV cranial nerves Result in stroke-like episodes.
- Shooting lancinating pains from sensory root irritation
- Positive Romberg's sign and broad-based ataxic gait from posterior column loss.
- Neurosyphilis: Argyll Robertson pupil with small irregular, optic atrophy, loss of deep pain sensation.
- Charcot's type joints due to loss of protective pain sensation Down going plantars
- Subacute combined degeneration (Vitamin B12 deficiency)
- Multiple sclerosis
- HIV myelopathy
- Nitrous oxide abuse
- Copper deficiency
- CSF may cause raised protein and raised WCC and oligoclonal bands
- TPHA FTAA. VDRL positive than negative after the treatment
- Motor nerve conduction velocity - normal
- MRI spine may demonstrate a high T2 signal in the dorsal cord with atrophy.
- BenzylPenicillin IV
- Beware of Herxheimer reaction due to release of toxins from spirochaetes
- May be ameliorated with steroids.