Neurosyphilis (NS) is caused by the invasion of Treponema pallidum into the central nervous system, which can occur in any stage of syphilis, especially in the late stage. Brain imaging could also aid the physician in discriminating these patients from those with a functional mental disorder. When the syphilis serology is positive, the patient should be examined thoroughly for neurosyphilis by lumbar puncture. This should be a part of the evaluation of patients with psychiatric disorders, especially patients with cognitive impairment. Our findings reinforce the importance of performing serologic testing for syphilis. Mood disturbances were the most common psychiatric disorder in the general paresis patients, especially agitation, between the two groups (patients with general paresis who were misdiagnosed as having primary psychiatric disease and patients who had never been misdiagnosed) ( p = 0.011). Only 43.3 % of misdiagnosed patients and 30.8 % of general paresis patients had positive results for the CSF rapid plasma reagin (RPR) test 96.4 % patients had abnormal neuroimaging. ResultĪll of the patients had positive assay results for cerebral spinal fluid (CSF) Treponema pallidum hemagglutination (TPHA). The demographic and clinical manifestations, laboratory tests, and neuroimaging and neuropsychological characteristics were analysed in 55 general paresis patients with psychiatric disorders, including 29 patients misdiagnosed as primary psychiatric disease and 26 patients diagnosed as having general paresis after being seen once by a doctor. The results may assist clinicians in the early identification of neurosyphilis with a mental disorder. The purpose of this study was to explore the differences in the clinical and neuropsychological characteristics of general paresis between patients misdiagnosed as having a primary psychiatric disease and patients diagnosed correctly upon seeing a doctor. Patients with a psychiatric manifestation are often misdiagnosed. Psychiatric disorders as a cause of general paresis have become more common due to the use of antibiotics. In addition, the manifestations of neurosyphilis are not typical. Neurosyphilis is the “great imitator” because it can mimic many types of medical disorders. The main manifestation of general paresis is dementia however, this is different from the other types of dementia, which can be cured by adequate doses of penicillin in the early stage. General paresis (GP) is a type of neurosyphilis. Conveniently, a popular mnemonic to remember Argyll Robertson pupils is that, just like prostitutes, they "accommodate but do not react".Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system. Named after Douglas Argyll Robertson (1837–1909), a Scottish surgeon and ophthalmologist, who first described this condition in mid-1860s in patients with neurosyphilis.Īrgyll Robertson pupils are also sometimes called "prostitute's pupils" because of their association with late neurosyphilis. The exact anatomical lesion behind this phenomenon is unknown but is thought to be caused by bilateral damage of the pretectal nuclei in the midbrain. When seen in these non-syphilitic etiologies, the pupil is termed ' pseudo-Argyll Robertson pupil' 3. It is a highly specific sign of late neurosyphilis, however can also occur in diabetic neuropathy, multiple sclerosis, alcoholic midbrain degeneration, and stroke 2,3. Argyll Robertson pupil is usually bilateral and presents as bilaterally miotic and irregular pupils, which constrict briskly with accommodation but do not react to bright light therefore displaying light-near dissociation 1.
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