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.

A. Meningovasculitis:

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.