Q 2.13. Neurolues

Neurosyphilis is often referred to as neurolues.



Neurosyphilis is an infection of the central nervous system (CNS) by the bacterium Treponema pallidum. It can occur at any stage after the initial syphilis infection.

Neurosyphilis is not contagious by itself; it is a complication of syphilis, which is a sexually transmitted infection (STI). Syphilis is transmitted through sexual contact with someone who has the infection. This includes unprotected vaginal, anal, or oral sex. The bacterium Treponema pallidum, which causes syphilis, can invade the brain and spinal cord, leading to neurosyphilis.

The pathogenesis of neurosyphilis begins with the invasion of the cerebrospinal fluid (CSF), which may happen shortly after acquiring the T. pallidum infection.


Clinical Symptoms

The clinical presentation of neurosyphilis is diverse and depends on the stage of the disease:

Early Neurosyphilis may present as asymptomatic or with symptoms of meningitis, including headache, neck stiffness, seizures, and cranial neuropathies.

Late Neurosyphilis includes general paralysis and tabes dorsalis, with symptoms like poor coordination, sensory deficits, and dementia.


In more details:

Stroke due to neurosyphilis is often a result of syphilitic endarteritis, which is an inflammation of the inner lining of the arteries. The affected vessels are typically medium-to-large meningeal arteries, and this condition is known as Heubner’s endarteritisPatients with meningovascular syphilis may present with multiple ischemic lesions visible on brain CT or MRI scans, indicative of cerebrovascular disease.


Tabes dorsalis is a late-stage manifestation of neurosyphilis, primarily affecting the spinal cord’s dorsal columns and dorsal root ganglia. It results from the chronic inflammation caused by the untreated syphilis bacterium, Treponema pallidum.

Key Features of Tabes Dorsalis:

  • Sensory Ataxia: Due to damage to the dorsal columns, patients experience a loss of proprioception, leading to an unsteady gait and balance issues.
  • Lancinating Pains: Patients often suffer from sudden, intense pains that may be exacerbated by movements or touch.
  • Hypoesthesia: There is a reduced sensation of touch, along with paresthesias, which are abnormal sensations like tingling or prickling.
  • Argyll Robertson Pupil: This refers to pupils that accommodate but do not react to light, indicative of neurosyphilis.
  • Reflexes: There may be a reduction or absence of deep tendon reflexes, such as the knee jerk reflex



It is typically made through clinical evaluation, serological tests, and examination of cerebrospinal fluid (CSF) for signs of syphilis infection.



The treatment of neurosyphilis typically involves antibiotic therapy, often with penicillin, to eradicate the T. pallidum bacterium. The specific treatment regimen may vary based on the stage of the disease and the presence of any complications. 

The primary treatment is penicillin, administered intravenously, which can halt the progression of the disease but may not reverse the damage already done



(1) Neurosyphilis – UpToDate. https://www.uptodate.com/contents/neurosyphilis.

(2) Neurosyphilis | Radiology Reference Article | Radiopaedia.org. https://radiopaedia.org/articles/neurosyphilis.

(3) en.wikipedia.org. https://en.wikipedia.org/wiki/Neurosyphilis.

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