Neurosyphilis is an infection of the brain or spinal cord. It occurs in persons with untreated syphilis many years after they are first infected.

Neurosyphilis occurs about 10 to 20 years after first being infected with syphilis. It is considered a life-threatening complication of syphilis. Not everyone who has syphilis will develop this complication.

There are four different forms of neurosyphilis:

• Asymptomatic
• Meningovascular
• Tabes dorsalis
• General paresis

Asymptomatic neurosyphilis occurs before symptomatic syphilis. Signs of the disease may be seen in the spinal fluid, but the person has no symptoms.

Meningovascular neurosyphilis causes nerve and eye problems, among other symptoms. There may be damage to the blood vessels, which can lead to a stroke.

Persons with tabes dorsalis have damage to the spinal cord that slowly gets worse, making them unable to walk.

In general paresis, brain cell damage causes paralysis, tremors, seizures, and mental decline. Inflammation may occur anywhere in the brain or spinal cord and can lead to a number of neurological problems.

• Headache
• Stiff neck
• Irritability
• Poor concentration
• Mental confusion
• Depression
• Visual disturbances
• Abnormal reflexes
• Abnormal gait (walk)
• Incontinence
• Dementia
• Weakness, numbness of lower extremities
• Loss of muscle function
• Muscle contractions
• Muscle atrophy

Blood tests can be done to detect substances produced by the bacteria that causes syphilis. The oldest test is the VDRL test.

In neurosyphilis, it is important to test the spinal fluid for signs of syphilis. Tests to look for problems with the nervous system may include:

• Lumbar puncture and a CSF fluid analysis
• Cranial CT scan
• MRI scan of the brain, brainstem, or spinal cord
• Cerebral angiogram