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Lumbar Puncture in Asymptomatic Neurosyphilis

Yehudi M. Felman, MD
Arch Intern Med. 1985;145(3):422-423. doi:10.1001/archinte.1985.00360030054010.
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Neurosyphilis occurs in about 10% of untreated patients with syphilis five to 35 years after the onset of their infection.1 The diagnosis of neurosyphilis has become difficult to establish in the penicillin era, because cases are diminishing in number and their mode of presentation is increasingly atypical. Symptomatic neurosyphilis exhibits neurologic or psychiatric disturbances along with various cerebrospinal fluid (CSF) abnormalities such as pleocytosis, elevated protein concentration, and/or reactive VDRL. The diagnosis of asymptomatic neurosyphilis, on the other hand, is made in the absence of clinical symptoms or signs of disturbance in the central nervous system, providing CSF abnormalities are present.2 A positive VDRL on the CSF, in the absence of signs or symptoms, establishes the diagnosis of asymptomatic neurosyphilis. A positive reagin test on the CSF will not, however, distinguish between past untreated or adequately treated infection and present infection. The activity of neurosyphilis is usually determined by elevated


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