[1] There is a wide variety of symptoms that neurosyphilis can present with depending on the affected structure of the central nervous system.

Late neurosyphilis typically involves the brain and spinal cord parenchyma, manifesting as tabes dorsalis and general paresis.

[2] Clinical history, a physical neurological examination, and a lumbar puncture to obtain cerebrospinal fluid (CSF) for analysis are crucial for diagnosing neurosyphilis.

Meningitis is the most-common neurological presentation in early syphilis, typically arising within one year of initial infection.

[6] It is due to inflammation of the blood vessels supplying the central nervous system, resulting in the death of brain tissue called ischemia.

The middle cerebral artery is most often affected, causing a variety of symptoms including weakness, sensory loss, eye deviation, and hemineglect syndrome.

Tabes dorsalis, also called locomotor ataxia, describes a constellation of symptoms resulting from a degenerative process of the posterior columns of the spinal cord.

[18] Otosyphilis refers to a type of neurosyphilis that affects the vestibulocochlear nerve, causing issues with hearing and balance.

[19] Ocular syphilis and otosyphilis may occur at any point after initial infection, and its presentation can overlap with other symptoms of neurosyphilis.

The pathogenesis is not fully known, in part due to fact that the organism is not easily cultured, making scientific experiments difficult.

[3] In primary or secondary syphilis, invasion of the protective membrane of the brain called the meninges may result in lymphocytic and plasma cell infiltration of perivascular spaces.

Tabes dorsalis thought to be due to irreversible loss of myelin in nerve fibers of the posterior columns of the spinal cord involving the lumbosacral and lower thoracic levels.

[6] Rarely, T. pallidum may invade any structures of the eye (such as cornea, anterior chamber, vitreous and choroid, and optic nerve) and cause local inflammation and edema.

[2] Common serum studies to diagnose syphilis include the rapid plasma reagin and the Venereal Disease Research Laboratory (VDRL) test.

The CSF white blood cell count is often elevated in neurosyphilis, but this finding is nonspecific and can be unreliable in patients with other infections such as HIV.

The Centers for Disease Control and Prevention recommend the following regimen: Alternatively: Follow-up blood serum tests are generally performed at 3, 6, 12, and 24 months to ensure successful treatment.

The exact mechanisms of reaction are unclear, however most likely caused by proinflammatory treponemal lipoproteins that are released from dead and dying organisms following antibiotic treatment.

The researchers failed to notify and withheld treatment for patients despite knowing penicillin was found as an effective cure for syphilis.