There have been frequent reports of
Neurosyphilis with atypical features. Syphilitic
infection of the central nervous system can result in various
movement disorders (MD). The few reports of MD patients with
neurosyphilis have been mainly of single patient. Between June 2005 and February 2012 we identified, 169 in-patients with
neurosyphilis at Zhongshan Hospital. We performed a retrospective chart review to characterize MD findings, clinical signs and symptoms, misdiagnosis rate, laboratory findings, and brain magnetic resonance imaging results. We found that seven of the 169
neurosyphilis patients presenting with MD, had originally been misdiagnosed with
Parkinsonism (4), laryngeal
dystonia (1),
corticobasal syndrome (1), and
sensory ataxia (1). None of these patients were initially suspected of having
neurosyphilis. The correct diagnosis was
syphilitic meningitis (1), meningovascular
neurosyphilis (2),
general paresis (3), and
tabes dorsalis (1). Among them, six patients had abnormal imaging studies, and sera rapid plasma
reagin (RPR) and Treponema pallidum particle agglutination (TPPA) from all seven patients were positive. The cerebrospinal fluid (CSF) examinations showed that four patients were CSF-RPR positive (titers ≤1:16) by CSF syphilitic serologic testing, but all seven patients were CSF-TPPA reactive. Moreover, two patients had CSF
pleocytosis and four patients had elevated CSF
protein expression. Our findings reinforced the importance of routine serologic testing for
syphilis should be a part of the evaluation of patients with atypical MD presentations or in whom alternative diagnoses are not forthcoming. When serology is positive, all patients should be examined more thoroughly for
neurosyphilis by lumbar puncture.