Rapidly progressive dementia due to neurosyphilis

Introduction: Dementia is a syndrome caused by a brain disease characterized by significant cognitive decline accompanied by psychological symptoms and behavioral changes. Rapidly progressive dementias (RPD) form a heterogeneous group of conditions that can evolve acutely or subacutely and are characterized by an evolution of less than two years. There are reversible dementias with symptoms similar to those of the progressive degenerative form which, with specific treatment, regress and the patient returns to normal. Neurosyphilis is a rare cause of reversible dementia today, due to increased early diagnosis and appropriate treatment over the years; however, diagnosis is sometimes overlooked and can lead to permanent sequelae. This report describes a case in which PRD is manifested as a consequence of neurosyphilis. Objectives: To report the importance of syphilis diagnosis and the proper treatment as way of avoid the unfavorable evolution of the disease. Methods: This descriptive observational report describes the case of a patient with neurosyphilis and rapidly progressive dementia as a manifestation of this disease. Data were collected from medical records, including serology results, cerebrospinal fluid with full analysis including serology (VDRL, FTA-ABS), magnetic resonance imaging (MRI) with brain contrast and infectious screening. Results (case report): A 51-year-old male patient, with no known comorbidities, ex-smoker and ex-alcoholic, was referred from the Basic Health Unit (BHU) to the tertiary neurology outpatient clinic due to a progressive picture of visual hallucinations, behavior change (irritability and apathy), dysarthria and tremor in the right upper limb 8 months ago, was previously admitted to psychiatric hospitals with a hypothesis of schizophrenia. Neurological physical examination: snout reflex present, perseveration, ecopraxia, visuospatial and temporal disorientation, bradykinesia with cogwheel rigidity in right upper limb, gait ataxia. During anamnesis, patient reports a previous treatment for syphilis with 1 dose of benzathine penicillin a few months ago, due to positive VDRL, denied syphilitic lesions. On admission, cerebrospinal fluid showed negative VDRL and FTA-ABS IgG positive and IgM negative. Serum VDRL 1/32 and other serologies negative. Brain MRI showing brain volume reduction and T2 hyperintense signal in the left hippocampus. Once the diagnosis of neurosyphilis was made and treatment with intravenous crystalline penicillin was started, the dementia regressed, showing behavioral and neurological improvement. Conclusion: This case shows the importance of neurosyphilis being part of the differential diagnosis of patients with RPD and that, with appropriate early treatment, it is possible to partially or completely reverse the symptoms.