Neurosyphilis is a disease caused by the infection of the nervous system by Treponema pallidum (the syphilis spirochete), and it is divided into congenital and acquired syphilis. So, what are the examination items for neurosyphilis?
Laboratory Tests
1. Asymptomatic neurosyphilis: Serological syphilis tests show positive reactions, and CSF examination reveals abnormal changes.
2. Meningeal neurosyphilis: Serum VDRL is positive in all patients. Lumbar puncture shows increased CSF pressure, mild turbidity, moderate increase in cell count (about 100-300 × 10^6/L), mild increase in protein, mild decrease in sugar in some patients, CSF-VDRL is positive in about 90% of cases, and FTA-ABS is positive.
3. Vascular neurosyphilis: Serum VDRL is positive, CSF pressure is mostly normal, white blood cells are below (100-200) × 10^6/L, mainly lymphocytes, protein content is mildly increased or normal, and FTA-ABS in both blood and CSF is positive.
4. Tabes dorsalis: Blood and CSF VDRL are both positive in 70% to 80% of cases. It is said that blood and CSF FTA-ABS reactions are both positive. In early patients, CSF mononuclear cells are mildly or moderately increased, and protein content is also increased. In late stages, the cell count is mostly below 50 × 10^6/L, still mainly lymphocytes.
5. General paresis: Serum VDRL tests are almost always positive, CSF pressure is basically normal, cell count is mostly (10-50) × 10^6/L, mainly lymphocytes, protein is increased, sugar and chloride are normal, CSF VDRL is 100% positive, and blood and CSF FTA-ABS are both positive.
6. Congenital neurosyphilis: Both blood and CSF syphilis tests are positive. The cell count and protein in CSF can be mildly to moderately increased, and IgG can also be increased.
Imaging Examinations
Imaging for vascular neurosyphilis: Brain CT shows single or several small low-density infarcts in the affected brain tissue. Cerebral angiography reveals diffuse and irregular stenosis of the affected cerebral arteries, indicating inflammatory proliferation of the vascular intima over a certain distance.
The following examinations have differential diagnostic significance: CT, MRI; EEG; skull base radiography; fundus examination.
Necessary selective examinations, chosen based on possible etiology:
1. Blood routine, blood biochemistry, electrolytes.
2. Blood sugar, immune tests, which have differential diagnostic significance.
