A case of late syphilis of the nervous system with a fatal outcome

Анотація

The article presents literature data on etiopathogenesis, classification, clinical features and diagnostics of neurosyphilis. The relevance of the problem is due to the social significance of the pathology, the complexity of establishing a diagnosis against the background of changes in symptoms and the course of syphilitic infection, and the relatively rare cases of late neurosyphilis. The purpose of the work is to present our own clinical observation of a case of neurosyphilis that ended in death. Upon urgent admission to the hospital, the patient showed clinical signs of general cerebral and focal syndromes (suppression of consciousness to the point of muffledness (Glasgow Coma Scale – 13 points), neuro-cognitive syndrome (MoCA – 21 points), sensory and sensitive disorders, left-sided reflex pyramidal insufficiency, oculomotor disorders – absence of miotic reaction to light, both direct and coordinated, with preservation of miotic reaction to the nearest stimulus (accommodation - convergence), pronounced vestibulo-atactic syndrome, mild amyostatic syndrome). The data of the patient's initial computed tomography examination did not confirm the diagnosis of acute cerebral circulation disorder. However, according to the results of magnetic resonance imaging of the brain (performed in T1, T2, FLAIR modes. SAG., AX., COR. projections) a picture of multifocal changes in the cerebellum, pons with edema of brain tissue, manifestations of encephalitis was obtained, which required lumbar puncture and additional examination. Total antibodies to Treponema pallidum were detected in the patient's blood. Despite the atypical clinical manifestations of syphilitic infection, based on the exa­mination data, a diagnosis of neurosyphilis was established, treatment was started, but the patient's condition worsened due to the rapid progression of circulatory disorders, psychoorganic syndrome, which led to the patient's death. Thus, with an atypical clinical picture, special vigilance should be exercised regarding the possible neurological manifestation of syphilitic infection; timely early diagnosis should be based on a comprehensive assessment of clinical and laboratory data and the involvement of a multidisciplinary team of doctors in making the diagnosis.