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. 2012:13:173-6.
doi: 10.12659/AJCR.883322. Epub 2012 Aug 7.

Neurosyphillis presenting with normal pressure hydrocephalus in a 76 year old man

Shaffer R S Mok  1 , Vivek Punjabi, David L Shklar
Affiliations

Neurosyphillis presenting with normal pressure hydrocephalus in a 76 year old man

Shaffer R S Mok et al. Am J Case Rep. 2012.

Abstract

Background: Normal pressure hydrocephalus (NPH) is composed of gait abnormalities, urinary incontinence and decline in mentation. It is uncommonly induced by syphilitic infection.

Case report: A 76 year-old male present with gait disturbances, urinary incontinence, declining vision and cognition, with a known diagnosis of NPH. He underwent therapeutic lumbar puncture (LP), which demonstrated leukocytosis and elevated protein. Venereal disease research laboratory testing (VDRL) was reactive in a 1:64 dilution with positive fluorescent Treponemal Antibody (FTA-Abs). The subject was treated with 14 days of Intravenous (IV) Penicillin 3 million units for 3 weeks and intramuscular benzathine PCN for 2 shots, with marked clinical improvement.

Conclusions: The incidence of Tabes Dorsalis is limited in the age of penicillin, especially in subjects without HIV. Subjects are diagnosed with either LP RPR or VDRL, confirmed with FTA-Abs. Common treatment is IV PCN 1.4-3 mU for 10-14 days.

Keywords: neurosyphillis; normal pressure hydrocephalus; tabes dorsalis.

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