VI. Central nervous system syphilis
Patients with syphilis may pass through a stage of asymptomatic syphilitic meningitis with the CSF showing an increased cell count and positive serologic reaction. A minority (10-20%) of patients will develop tertiary neurosyphilis years later. There are 3 types of tertiary neurosyphilis, which may occur alone or in combination.
1. Pathology: Infiltration of meninges and vessels by lymphocytes and plasma cells; may cause symptoms of meningitis or vascular occlusion.
2. Clinical symptoms: similar to low grade meningitis and/or "stroke" (due to vascular occlusion).
B. Paretic Neurosyphilis (General Paresis):
1. Pathology: Atrophy, loss of cortical neurons especially in frontal lobes, gliosis, proliferation of microglial cells (rod cells), perivascular lymphocytes and plasma cells. Spirochetes present in brain tissue.
2. Clinical symptoms: mental changes, progressing to dementia; headache.