argyll robertson pupil clinical significance

We hereby describe a case of neurosyphilis who presented with severe orofacial involuntary movements, Argyll Robertson pupil, and frequent oral automatism seizures. Until now, the response of different clinical symptoms to penicillin is little known.

If untreated, the infections may involve the brain parenchyma, and the conditions would be worsened with the appearance of general paresis, tabes dorsalis, and Argyll–Robertson pupil ( 2). Neurosyphilis shows a wide range of clinical symptoms, including seizures, poor vision, stroke, confusion, and personality changes ( 1). After treatment with penicillin, PLED and seizures disappeared and behavioral changes and memory decline were significantly improved, but rhythmic orofacial involuntary movements and Argyll Robertson pupil persisted, which indicates an irreversible characteristic of late stage neurosyphilis syndromes. In this paper, we analyzed the clinical video-electroencephalogram (EEG) features of neurosyphilis in a 54-year-old man who exhibited with rhythmic orofacial involuntary movements, Argyll Robertson pupil, frequent paroxysmal oral-automatism seizures, periodic lateralized discharges (PLEDs) with triphasic waves, behavioral changes, and memory decline. Patients with neurosyphilis present with a wide range of neurological symptoms, the response of which to penicillin is not well known.

2Department of Neurology, Xing Yuan hospital of Yulin, Shaanxi, China.

1Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.

Furthermore, a lumbar puncture is suggested in all HIV patients with syphilis regardless of their presenting symptoms.ĬSF findings indicative of neurosyphilis will show greater than 20 WBC/microL, and return positive for VRDL and intrathecal pallidum antibody index.Xiaoli Wang 1 †, Pengying Mu 1,2 †, Wenjuan Zhang 1 and Yonghong Liu 1 * Lumbar puncture is required in the evaluation of a patient with known syphilis presenting with these same symptoms. More commonly, however, non-treponemal blood work for VRDL (venereal disease research laboratory) or RPR (rapid plasma reagin) is sent to rule in the disease, and then confirmatory testing assessing for FTA-ABS (fluorescent treponemal antibody absorption), TPPA ( Treponema pallidum particle agglutination assay) or EIAs (syphilis enzyme immunoassays) is obtained.Ī lumbar puncture can be useful in the diagnosis of neurosyphilis in a patient with an unknown syphilis history who is presenting with neurologic and ocular disease that could be consistent with the disease. The gold standard remains visualization of spirochetes on darkfield microscopy. Additionally globally, reports have indicated that syphilis has been on the rise in conjunction with the global HIV/AIDs epidemic. The US CDC data estimates that 5% of MSM with syphilis are also infected with HIV. There is a high rate of co-infection with HIV in those MSM patients who have contracted syphilis.

This may be due to the fact that syphilis is more common in MSM, many of whom concurrently also have HIV, or it could reflect two separate groups with increased susceptibility. From 2000 to 2016, the rise in reported syphilis cases is primarily due to increased cases in the men who have sex with men population. The CDC acknowledges, however, that the disease is likely under-reported. According to the CDC: there were 30,676 cases of late and late latent cases of neurosyphilis reported in the United States in 2016. However, in the modern era, the number of cases of primary and secondary syphilis have been increasing every year since 2001, and continue to rise. The exam finding of Argyll Robertson pupils has been rare in the developed world since the advent of penicillin in the 1940s.

Argyll robertson pupil clinical significance