Abstract

Neurosyphilis, a complication of untreated syphilis infection, represents a formidable intersection of infectious disease and neurology. While once a common occurrence in the pre-antibiotic era, its incidence has decreased significantly in developed countries with widespread use of antibiotics. However, its persistence in certain populations and its potential resurgence in the context of evolving antibiotic resistance warrant continued vigilance and understanding. This article explores the pathophysiology, clinical manifestations, diagnosis, and treatment of neurosyphilis.

Syphilis is caused by the bacterium Treponema pallidum, a spirochete capable of invading the human body through mucous membranes or breaks in the skin. Initial infection manifests as a painless ulcer (chancre) at the site of entry, followed by a secondary stage characterized by rash and mucous membrane lesions. If left untreated, the infection progresses to the latent and tertiary stages, during which T. pallidum can disseminate throughout the body, including the central nervous system (CNS).

Neurosyphilis occurs when T. pallidum invades the CNS, typically through the blood-brain barrier. The bacteria can directly infect the meninges, brain parenchyma, spinal cord, and cranial nerves, leading to a variety of neurological complications.