Modern neuropsychiatric presentation of neurosyphilis.

As a cause of neuropsychiatric disease, non-HIV related neurosyphilis became uncommon enough for the American Academy of Neurology to drop lumbar puncture from its suggested list of tests for dementia. We reviewed 17 inpatient charts with Centers for Disease Control (CDC) guidelines with definite or probable neurosyphilis. Sixteen presented with neuropsychiatric symptoms, four with overt psychosis. An intensive workup, including lumbar puncture, should be considered in middle-aged patients with new onset neuropsychiatric symptoms. Syphilis, “the great imitator,” used to be part of the standard differential diagnosis of neuropsychiatric disease. With the advent of modern treatment, the incidence of tertiary syphilis has greatly declined. The disease is now considered unusual, except in the context of HIV infection. After anecdotally noting a number of cases, we wished to quantify the number and presentation of cases at our institution.