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Dementia & Neuropsychologia

versão impressa ISSN 1980-5764

Dement. neuropsychol. vol.4 no.4 São Paulo out./dez. 2010

https://doi.org/10.1590/S1980-57642010DN40400014 

Original Articles

Did you rule out neurosyphilis?

Você excluiu neurossífilis?

Ricardo Nitrini 1  

Anderson Rodrigues Brandão de Paiva 2  

Leonel Tadao Takada 3  

Sonia Maria Dozzi Brucki 4  

1-4MD, PhD, Behavioral and Cognitive Neurology Unit, Department of Neurology, and Cognitive Disorders Reference Center (CEREDIC), Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo SP, Brazil.


Abstract

Neurosyphilis, formerly a frequent cause of dementia, is now a rare condition in developed countries. However, syphilis remains common in many developing countries, where adequate diagnosis and treatment of early syphilis may be lacking, increasing the chances of neurosyphilis and prevalence of syphilitic dementia. Objectives: To present cases of syphilitic dementia seen in a cognitive and behavioral neurology unit in Brazil, emphasizing their first symptoms and the challenges they posed in diagnosis. Methods: At our unit of the Hospital das Clínicas of the University of São Paulo, all patients are submitted to blood treponemal tests. When the test is positive, a lumbar puncture is performed. We retrospectivelly reviewed all cases of neurosyphilis seen in our unit from January 1991 to November 2009. Results: Nine cases of neurosyphilis (0.77% of the 1160 cases in our files) were identified over the period. Patients with neurosyphilis were all men, had a mean age of 47.8 (±13.0) years (median of 43 years), and presented with various neuropsychiatric syndromes and elusive diagnoses. The median time from onset of symptoms to diagnosis was 24 months and only one patient made a full recovery after treatment. Conclusions: Neurosyphilis is not frequent but remains present, causing several types of neuropsychiatric syndromes. As it is very simple to rule out neurosyphilis by performing a blood treponemal test, this test should be performed in all patients with neuropsychiatric symptoms, particularly in regions of the world where syphilis is still a commonly occurring disease.

Key words: neurosyphilis; syphilis; dementia; neuropsychiatry; paretic neurosyphilis

Resumo

Neurossífilis, anteriormente uma causa freqüente de demência, é atualmente rara nos países desenvolvidos. A sífilis é ainda uma doença comum em muitos países em desenvolvimento, onde o diagnóstico e tratamento da sífilis precoce podem não ser adequados, o que aumenta a possibilidade de ocorrência de neurossífilis e de demência. Objetivos: apresentar casos de demência sifilítica atendidos em uma unidade de neurologia cognitiva e do comportamento no Brasil, enfatizando os primeiros sintomas e os desafios que impuseram ao diagnóstico. Métodos: Em nossa unidade do Hospital das Clínicas da Universidade de São Paulo, todos os pacientes são submetidos a teste treponêmico no sangue. Quando o teste é positivo, é realizada punção lombar. Avaliamos retrospectivamente todos os casos de neurossífilis atendidos em nossa unidade de janeiro de 1991 a novembro de 2009. Resultados: Nove casos de neurossífilis (0,77% dos 1.160 casos de nossos arquivos) foram identificados neste período. Os pacientes com neurossífilis eram todos homens, com idade média de 47,8 (±13,0) anos (mediana de 43 anos), e apresentaram-se com vários tipos de síndromes neuropsiquiátricas, de difícil diagnóstico. O tempo médio entre o início dos sintomas e o diagnóstico foi de 24 meses e apenas um paciente teve recuperação completa após o tratamento. Conclusões: Neurossífilis não é frequente, mas ainda está presente causando vários tipos de síndromes neuropsiquiátricas. Como é muito simples excluir o diagnóstico de neurossífilis mediante teste treponêmico no sangue, este teste deve ser realizado em todo paciente com sintomas neuropsiquiátricos, particularmente nas regiões do mundo onde a sífilis é ainda uma doença comum.

Palavras-chave: neurossífilis; sífilis; demência; neuropsiquiatria; paralisia geral progressiva

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Received: July 10, 2010; Accepted: September 11, 2010

Ricardo Nitrini - Rua Itapeva, 378 / cj. 93 - 01332-000 São Paulo SP - Brazil. E-mail: rnitrini@uol.com.br

Disclosure: The authors report no conflicts of interest

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