Srp Ark Celok Lek
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Neurosyphilis is still a significant medical problem in developing countries and its occurrence in HIV infection is the reason for a growing number of new cases in developed countries [1-4]. Personality changes are the commonest symptom of late neurosyphilis [5]. Neurologic deficits are usually due to syphilitic vasculitis with lacunar infarctions [6]. The laboratory confirmation of neurosyphilis must depend on a cluster of tests (Venereal Disease Research Laboratories--VDRL; Fluorescent Treponemal Antibody-Absorption--FTA-ABS; Treponema Pallidum Immobilization--TPI or Nelson-Mayer). The diagnosis of active neurosyphilis also requires an inflammatory cerebrospinal fluid (CSF) test [4]. ⋯ None of our patients reported previous venereal disease. They complained of impaired gait, headache, hearing loss, speech difficulties, forgetfulness, and mood changes. Pupillary changes, hemiparesis, gait disturbances and cerebellar signs, hearing loss, dysarthria, paraparesis, hypesthesia, mood disorders, mild cognitive decline and tremor of the tongue and hands were found during the examination. Pupillary signs are the most important symptoms because they can point to neurosyphilis. A two-step approach is recommended for establishing the diagnosis of syphilis with simple nontreponemal tests for screening purpose, and specific treponemal tests for its confirmation [21]. In our patients all but one were positive for syphilis in serum-tests and/or CSF. (ABS