5,6) Neurosyphilis may be asymptomatic or symptomatic, manifesting in the latter as syphilitic meningitis, meningovascular
syphilis, or parenchymatous neurosyphilis.
How HIV may affect the course and treatment of syphilis * Higher RPR or T pallidum hemagglutination assay titer * False-negative syphilis serology * More frequent prozone phenomenon (* 68) * Higher rate of asymptomatic primary syphilis (66-68) * Multiple or deeper chancres during primary syphilis (69) * Overlap of primary- and secondary-stage features of syphilis (66,68) * Shorter latency period before meningovascular
syphilis * Increased rate of early neurologic and ophthalmic involvement (66,68) * More rapid progression to tertiary manifestations (69) * Reduced efficacy of standard therapy for early syphilis ([dagger] 66) * More frequent relapse ([dagger] 68,70) * Delayed normalization of CSF values after treatment (69) Adapted from Pialoux et al.
Experience of meningovascular
syphilis in human immunodeficiency virus infected patient.
To the best of our knowledge, only 3 cases of medial or mediolateral medullary infarction and the classic clinical features of central Tapia syndrome have been described during the past century; 2 of these patients had brainstem infarctions, and 1 had meningovascular
syphilis occurs due to involvement of blood vessels in the subarachnoid space resulting in arteritis, leading to thrombosis, infarction and ischemia.