Neurosyphilis occurs in 15 to 20% of all late or tertiary syphilis infections (about 10 to 20 years after the primary infection), and is a progressive, life-threatening complication. There are 4 different forms of neurosyphilis: asymptomatic, meningovascular, tabes dorsalis, and general paresis. Asymptomatic neurosyphilis precedes symptomatic syphilis and is present in 15% of those with latent (hidden) syphilis. In this case, abnormalities may be present in the cerebrospinal fluid, but no symptoms are present. In meningovascular neurosyphilis, cranial nerve palsies and pupil abnormalities may be among a wide variety of symptoms. This may also cause damage to blood vessels resulting in stroke. In tabes dorsalis, progressive degeneration of the spinal cord occurs causing an inability to walk. In general paresis, paralysis, tremors, seizures, and mental decline occur as a result of damage to brain cells. Gummas (inflammatory lesions) may occur anywhere in the brain or spinal cord and can cause a wide variety of neurologic deficits. Syphilitic aseptic meningitis occurs as a chronic infection and may involve headaches, cognitive changes and cranial nerve abnormalities.
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