NEUROSYPHILIS

A 51 year old male with a past history of an ascending aortic aneurysm resected 2 years previously presents with "lightning" pains in legs and hands along with staggering gait. He states that he was treated for gonorrhea 30 years previously when he was in the navy. Neurologic exam revealed a difference in pupillary diameter with poor pupillary reaction to light. Remainder of cranial nerves were intact. He exhibited decreased vibratory sense, proprioception and touch in the lower limbs.

1. What laboratory test would you order in this patient?

1. serum FTA-ABS
2. CBC and serum glucose
3. CSF studies including FTS-ABS on lumbar puncture specimen after a CT scan rules out an intracranial mass.
4. All of the above

2. CSF studies revealed a normal protein, normal glucose, and a lymphocytic pleocytosis. The CSF-FTA-ABS was positive. Based on the above clinical presentation and laboratory data, what is this patients most likely diagnosis?

1. Lyme disease with a false positive FTA-ABS
2. Tabes Dorsalis
3. Guillian Barre Syndrome
4. Progressive multifocal leukoencephalopathy

ANSWER: B

3. Evaluation of this patients spinal cord would likely reveal:

1. axonal loss in the posterior columns
2. spirochetes in the posterior columns
3. demyelination of the corticospinal tracts
4. axonal degeneration in the ascending tracts of the posterior columns and the descending pyramidal tracts

4. Which of the following statement(s) is/are true regarding neuroborreliosis

1. it may present as aseptic meningitis
2. it may present as a polyneuropathy
3. organisms may be identified with a Dieterle stain
4. histogically, vasculitis and granulomas may be found
5. all of the above

5. Morphologic features which may be seen in neurosyphilis include which of the following:

1. obliterative endarteritis in leptomeninges
2. cerebral gummas
3. spirochetal invasion of cerebral cortex
4. granular ependymitis
5. all of the above