Medicine Department, Federal University of Santa Maria, Santa Maria, Brazil.
Neurol India. 2022 Jul-Aug;70(4):1635-1638. doi: 10.4103/0028-3886.355119.
BACKGROUND/OBJECTIVE: Neurosyphilis can be associated with a variety of clinical manifestations. There are only a few cases of neurosyphilis associated with parkinsonism-plus syndromes (PPSs) that have been reported in the literature. We describe a case of an elderly woman who presented with abnormal gait and progressive visual disturbance, probably secondary to neurosyphilis.
Literature search was performed in Embase, Google Scholar, Medline, Scielo, and ScienceDirect using a set of terms that included parkinsonism, tremor, and syphilis.
A 64-year-old female was admitted because of vision problems, gait disturbances, and cognitive impairment. The neurological examination revealed bradykinesia, rigidity, and rest tremor. The pupils were bilaterally small and reacted in size to a near object but did not constrict when exposed to bright light. The conjugate eye movements showed a defective downward gaze. On neuropsychological examination, the mini-mental state exam showed a moderate cognitive impairment. Reduced phonemic fluency was observed. A positive serum venereal disease research laboratory (VDRL) test was noted. A cerebrospinal fluid analysis showed positive VDRL. Brain and cervical spine magnetic resonance imaging was normal. An electro-encephalogram showed diffused slow waves. Penicillin G was started. Six months after, the patient had a full recovery of her conjugate eye movements and cognitive functions. Upon further questioning, the patient reported no response with a levodopa attempt.
To the authors' knowledge, two individuals developed progressive supra-nuclear palsy (PSP), and one presented corticobasal degeneration (CBD), probably associated with neurosyphilis. This is the second case to document the occurrence of a progressive supra-nuclear palsy because of syphilis.
背景/目的：神经梅毒可引起多种临床表现。文献中仅有少数几例神经梅毒伴帕金森病综合征（PPS）的病例报道。我们描述了一例老年女性患者，她表现为步态异常和进行性视力障碍，可能继发于神经梅毒。
我们在 Embase、Google Scholar、Medline、Scielo 和 ScienceDirect 中使用了一组包括帕金森病、震颤和梅毒在内的术语进行文献检索。
一名 64 岁女性因视力问题、步态障碍和认知障碍入院。神经系统检查显示运动迟缓、僵硬和静止性震颤。瞳孔双侧缩小，对近距离物体的反应大小正常，但对强光无收缩反应。双眼共轭运动显示向下注视缺陷。神经心理学检查显示，简易精神状态检查显示中度认知障碍。观察到语音流畅性降低。血清性病研究实验室（VDRL）检查呈阳性。脑脊液分析显示 VDRL 阳性。脑和颈椎磁共振成像正常。脑电图显示弥漫性慢波。开始使用青霉素 G。6 个月后，患者的共轭眼运动和认知功能完全恢复。进一步询问时，患者报告没有对左旋多巴有反应。
据作者所知，有 2 人发展为进行性核上性麻痹（PSP），1 人发展为皮质基底节变性（CBD），可能与神经梅毒有关。这是第二例因梅毒引起进行性核上性麻痹的病例。
