neurologic disorders
Subacute and Chronic Meningitis
Syphilitic meningitis
Syphilitic meningitis is less common; it is usually a feature of Late or tertiary syphilis . The meningitis may be acute or chronic. It may be accompanied by complications such as cerebrovascular arteritis (possibly causing thrombosis with ischemia or infarction), retinitis, cranial nerve deficits (especially of the 7th cranial nerve), or myelitis. CSF findings may include Pleocytosis (usually lymphocytic) Elevated protein Low glucose These abnormalities may be more pronounced in patients with AIDS. Diagnosis of syphilitic meningitis is based on serum and CSF serologic tests, followed by fluorescent treponemal antibody absorption (FTA-ABS) testing to confirm. Magnetic resonance angiography and cerebral angiography may accurately differentiate between parenchymal disease and arteritis. Patients with syphilitic meningitis are treated with aqueous penicillin 12 to 24 million units IV/day given in divided doses every 4 hours (eg, 2 to 4 million units every 4 hours) for 10 to 14 days. 