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[PMID]: 29478035
[Au] Autor:Hobbs E; Vera JH; Marks M; Barritt AW; Ridha BH; Lawrence D
[Ad] Address:Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
[Ti] Title:Neurosyphilis in patients with HIV.
[So] Source:Pract Neurol;, 2018 Feb 24.
[Is] ISSN:1474-7766
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180225
[Lr] Last revision date:180225
[St] Status:Publisher

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[PMID]: 29193072
[Au] Autor:Byard RW
[Ad] Address:School of Medicine, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
[Ti] Title:Syphilis-Cardiovascular Manifestations of the Great Imitator.
[So] Source:J Forensic Sci;, 2017 Nov 28.
[Is] ISSN:1556-4029
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Rates of syphilis are beginning to once again increase, with the World Health Organization estimating that in recent years there were 12 million new cases of syphilis each year; in 2002, syphilis was responsible for 0.3% of deaths globally. At-risk groups include young males (20-29 years), prisoners, and sex workers. Increased rates in young females have elevated the numbers of congenital cases. Review of the University of Adelaide Pathology Archive revealed four cases with significant pathology, which included cardiac gummas and aortic arch aneurysms. These cases demonstrate the cardiovascular characteristics of untreated syphilis in the tertiary stage. Cases with such advanced pathology will only occur where diagnoses have not been made, and/or standard antibiotic therapy has not been implemented in the early stage of disease.
[Pt] Publication type:CASE REPORTS
[Em] Entry month:1712
[Cu] Class update date: 171201
[Lr] Last revision date:171201
[St] Status:Publisher
[do] DOI:10.1111/1556-4029.13709

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[PMID]: 28978899
[Au] Autor:Kishikawa H; Wajima Z; Shitara T; Shimizu T; Adachi H; Sakamoto A
[Ad] Address:Department of Anesthesiology, Nippon Medical School.
[Ti] Title:Subarachnoid Block-Induced Deafferentation Pain Successfully Treated with Pentazocine.
[So] Source:J Nippon Med Sch;84(4):183-185, 2017.
[Is] ISSN:1347-3409
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:Deafferentation pain induced by subarachnoid block (SAB) is rare, but it can appear in the form of recurrent phantom lower limb pain, new acute-onset stump pain in amputees, lower limb pain in patients with tabes dorsalis, and neuropathic pain. We have previously reported that thiopental is an effective treatment for deafferentation pain induced by therapeutic SAB applied to treat neuropathic pain of central origin. Here, we report the case of an amputee who developed new stump pain in his lower limb immediately after subarachnoid tetracaine was administered prior to appendectomy. A 51-year-old man who had previously undergone right below-knee amputation for acute arterial thrombosis, and who had not previously experienced chronic phantom limb or stump pain, was scheduled for emergency open appendectomy. For anesthesia, we induced SAB with a hyperbaric tetracaine solution. No paresthesia occurred during administration. However, the patient immediately complained of severe, lightning-bolt pain in the right lower limb stump after the SAB was established. He was given intravenous pentazocine, which promptly resolved the pain. Appendectomy was then performed under sedation using intravenous midazolam. The patient did not experience further deafferentation pain during his hospital stay and has reported no stump pain since discharge from the hospital. This case report suggests that SAB induces deafferentation pain in some patients and that this unusual pain can be treated with pentazocine.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171005
[Lr] Last revision date:171005
[St] Status:In-Process
[do] DOI:10.1272/jnms.84.183

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[PMID]: 28859081
[Au] Autor:Marks M; Jarvis JN; Howlett W; Mabey DCW
[Ad] Address:Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
[Ti] Title:Neurosyphilis in Africa: A systematic review.
[So] Source:PLoS Negl Trop Dis;11(8):e0005880, 2017 Aug.
[Is] ISSN:1935-2735
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Neurological involvement is one of the most important clinical manifestations of syphilis and neurological disease occurs in both early and late syphilis. The impact of HIV co-infection on clinical neurosyphilis remains unclear. The highest prevalence of both syphilis and HIV is in Africa. Therefore it might be expected that neurosyphilis would be an important and not uncommon manifestation of syphilis in Africa and frequently occur in association with HIV co-infection; yet few data are available on neurosyphilis in Africa. The aim of this study is to review data on neurosyphilis in Africa since the onset of the HIV epidemic. METHODS: We searched the literature for references on neurosyphilis in Africa for studies published between the 1st of January 1990 and 15th February 2017. We included case reports, case series, and retrospective and prospective cohort and case-control studies. We did not limit inclusion based on the diagnostic criteria used for neurosyphilis. For retrospective and prospective cohorts, we calculated the proportion of study participants who were diagnosed with neurosyphilis according to the individual study criteria. Depending on the study, we assessed the proportion of patients with syphilis found to have neurosyphilis, and the proportion of patients with neurological syndromes who had neurosyphilis. Due to heterogeneity of data no formal pooling of the data or meta-analysis was undertaken. RESULTS: Amongst patients presenting with a neurological syndrome, three studies of patients with meningitis were identified; neurosyphilis was consistently reported to cause approximately 3% of all cases. Three studies on stroke reported mixed findings but were limited due to the small number of patients undergoing CSF examination, whilst neurosyphilis continued to be reported as a common cause of dementia in studies from North Africa. Ten studies reported on cases of neurosyphilis amongst patients known to have syphilis. Studies from both North and Southern Africa continue to report cases of late stage syphilis, including tabes dorsalis and neurosyphilis, in association with ocular disease. DISCUSSION: This is the first systematic review of the literature on neurosyphilis in Africa since the beginning of the HIV epidemic. Neurosyphilis continues to be reported as a manifestation of both early and late syphilis, but the methodological quality of the majority of the included studies was poor. Future well-designed prospective studies are needed to better delineate the incidence and clinical spectrum of neurosyphilis in Africa and to better define interactions with HIV in this setting.
[Mh] MeSH terms primary: Coinfection/epidemiology
HIV Infections/epidemiology
Neurosyphilis/epidemiology
[Mh] MeSH terms secundary: Africa/epidemiology
Humans
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1709
[Cu] Class update date: 171025
[Lr] Last revision date:171025
[Js] Journal subset:IM
[Da] Date of entry for processing:170901
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pntd.0005880

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[PMID]: 28521659
[Au] Autor:Olry R; Haines DE
[Ad] Address:a Département d'Anatomie , Université du Québec à Trois-Rivières , Trois-Rivières , Québec , Canada.
[Ti] Title:Tabes dorsalis: Not, at all, "Elementary my dear Watson!"
[So] Source:J Hist Neurosci;:1-6, 2017 May 19.
[Is] ISSN:1744-5213
[Cp] Country of publication:England
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1705
[Cu] Class update date: 170620
[Lr] Last revision date:170620
[St] Status:Publisher
[do] DOI:10.1080/0964704X.2017.1326240

  6 / 497 MEDLINE  
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[PMID]: 28291299
[Au] Autor:Akinci E; Öncü F; Topçular B
[Ti] Title:Psikiyatri Kliniginde Nörosifiliz: Üç Olgu Bildirimi. [Neurosyphilis in Psychiatric Settings: Three Case Reports].
[So] Source:Turk Psikiyatri Derg;28(1):61-66, 2017.
[Is] ISSN:1300-2163
[Cp] Country of publication:Turkey
[La] Language:tur
[Ab] Abstract:Syphilis is a generally sexually transmitted and multisystem disease caused by the spirochete Treponema pallidum. All of the organs of the body may be involved during the course of the disease. Neurosyphilis is a clinical form of syphilis with the central nervous system (CNS) involvement. While primarily meningeal and vascular structures are involved in early neurosyphilis, a parenchymal affection of the brain and spinal cord emerges at later stages of neurosyphilis. It presents with symptoms of meningitis, meningovasculitis and parenchymal neurosyphilis (presenting as tabes dorsalis and general paresis). Clinically, it can mimic a variety of psychiatric disorders such as depression, psychosis, mania, delirium, personality changes and dementia. During its progression making presentations similar to many systemic or neuropsychiatric diseases, syphilis is defined as "great imitator". Nowadays, neurosyphilis is a rare disease as a result of the widespread use of antibiotics that must be kept in mind in the differential diagnosis of neurological and psychiatric disorders. In this article, three neurosyphilis cases with different psychiatric presentations are reported and literature relevant to syphilis are reviewed.
[Mh] MeSH terms primary: Neurosyphilis/diagnosis
Psychotic Disorders/etiology
[Mh] MeSH terms secundary: Adult
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuroimaging
Neurosyphilis/complications
Neurosyphilis/diagnostic imaging
Neurosyphilis/psychology
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 170828
[Lr] Last revision date:170828
[Js] Journal subset:IM
[Da] Date of entry for processing:170315
[St] Status:MEDLINE

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[PMID]: 28220718
[Au] Autor:de Bruijn S; Kenyon C; Léonard N; Vlieghe E
[Ad] Address:a Department of Tropical Medicine , Antwerp University Hospital , Edegem , Belgium.
[Ti] Title:The big imitator strikes again: a case report of neurosyphilis in a patient with newly diagnosed HIV.
[So] Source:Acta Clin Belg;72(5):372-374, 2017 Oct.
[Is] ISSN:2295-3337
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Neurosyphilis is the result of an infection of the central nervous system caused by the spirochete Treponema pallidum. Its clinical presentation includes meningovascular syphilis, tabes dorsalis, and dementia paralytica, resulting in a wide range of symptoms such as psychosis, Parkinsonism, and depression. CASE REPORT: A 49-year-old male was admitted to a psychiatric hospital because of social withdrawal and self-neglect, indicative of a major depression. A routine HIV-test was positive and resulted in an admission to the Antwerp University Hospital. Clinical examination showed Argyll Robertson pupils, a wide-based gait, absence of vibration sense in the lower limbs, and a MMSE-score of 25/30. Blood analysis revealed a CD4+ count of 99 cells/µL and a HIV viral load of 2,13 × 10 copies/mL plasma. A serum TPHA (T. pallidum hemagglutination assay) titre of 1/20480 and RPR (rapid plasma reagin) titre of 1/128 were detected. TPHA and RPR titre in the cerebrospinal fluid were, respectively, 1/10240 and 1/4. A brain MRI showed diffuse cortical atrophy and lesions in the white matter compatible with HIV-encephalopathy. The diagnoses of advanced HIV-infection and late neurosyphilis were made. HAART (highly active antiretroviral therapy) and high-dose IV penicillin G were started. CONCLUSION: In all patients with new-onset dementia or untreatable psychosis, neurosyphilis should always be considered. Argyll Robertson pupils are regarded as pathognomonic of neurosyphilis. The management of neurosyphilis includes high-dose IV benzyl penicillin for 10 to 14 days. Close follow-up including a lumbar puncture after 6 months is warranted to ensure treatment recovery.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1702
[Cu] Class update date: 170919
[Lr] Last revision date:170919
[St] Status:In-Process
[do] DOI:10.1080/17843286.2017.1290890

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[PMID]: 27959596
[Au] Autor:Osman C; Clark TW
[Ad] Address:University of Southampton, Southampton, United Kingdom chinar.osman@uhs.nhs.uk.
[Ti] Title:Tabes Dorsalis and Argyll Robertson Pupils.
[So] Source:N Engl J Med;375(20):e40, 2016 Nov 17.
[Is] ISSN:1533-4406
[Cp] Country of publication:United States
[La] Language:eng
[Mh] MeSH terms primary: HIV Infections/complications
Tabes Dorsalis/diagnosis
[Mh] MeSH terms secundary: Humans
Male
Middle Aged
Pupil Disorders/etiology
Tabes Dorsalis/complications
Treponema pallidum/isolation & purification
Viral Load
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1612
[Cu] Class update date: 161230
[Lr] Last revision date:161230
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:161214
[St] Status:MEDLINE

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[PMID]: 27937025
[Au] Autor:Ellis H
[Ad] Address:Emeritus Professor of Surgery, Guy's, King's and St Thomas' School of Biomedical Sciences, London SE1 1UL.
[Ti] Title:Sir William Gull: distinguished physician.
[So] Source:Br J Hosp Med (Lond);77(12):717, 2016 Dec 02.
[Is] ISSN:1750-8460
[Cp] Country of publication:England
[La] Language:eng
[Mh] MeSH terms primary: History of Medicine
[Mh] MeSH terms secundary: Anorexia Nervosa/history
History, 19th Century
Myxedema
Tabes Dorsalis/history
United Kingdom
[Pt] Publication type:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE
[Ps] Personal name as subject:Gull W
[Em] Entry month:1703
[Cu] Class update date: 170309
[Lr] Last revision date:170309
[Js] Journal subset:IM
[Da] Date of entry for processing:161213
[St] Status:MEDLINE

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[PMID]: 27434214
[Au] Autor:Bogousslavsky J; Tatu L
[Ad] Address:Swiss Medical Network Neurocentre, Genolier-Glion/Montreux-Lausanne-Geneva-Lugano-Fribourg-Neuchatel-Basel-Zurich, Clinique Valmont, Glion sur Montreux, Switzerland.
[Ti] Title:Édouard Manet's Tabes Dorsalis: From Painful Ataxia to Phantom Limb.
[So] Source:Eur Neurol;76(1-2):75-84, 2016.
[Is] ISSN:1421-9913
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:Édouard Manet (1832-1883) is considered the 'father' of Impressionism and even of XXth century modern art. Manet's genius involved getting away from the classical narrative or historical topics and replacing them by the banality of daily life. Technically, he erased volumes into flat two-dimensional coloured planes, and distorted conventional perspective with often gross brushstrokes intentionally giving an 'unfinished' aspect to the work. It is little known that Manet had a very painful second part of his life, due to excruciating limb and chest pains, which developed in parallel with proprioceptive ataxia and gait imbalance. Manet always remained discreet about his private life, and we mainly know that his future wife was his family piano teacher, with whom he had a liaison already at age 17. Later, the great but platonic passion of his life was the painter Berthe Morisot (1841-1895), who got married to Manet's brother Eugène. In fact, we do not know whether he had any mistress at all, although he had several elegant 'flirts' in the mundane and artistic milieu. Thus, while Manet's progressive painful ataxia from age 40 yields little doubt on its tabetic origin, how he contracted syphilis at least 15-20 years before will probably remain a mystery. It is fascinating that Manet's daily struggle against pain and poor coordination may have led his art to become one of the most significant of modern times, opening the way to XXth century avant-gardes, along with another victim of syphilis, Paul Gauguin (1848-1903). Manet never showed any sign of General Paresis, and like his contemporary the writer Alphonse Daudet, his clinical picture remained dominated by paroxysmal pain and walking impairment. Difficult hand coordination made him quit watercolor painting, and during the last 2 years of his life, he had to focus on small format oil works, whose subject was nearly limited to modest bunches of fresh flowers, now often considered to be his maturity masterpieces. Having become bedridden, he had to be amputated of one leg, which was developing gangrene probably associated with ergot overuse. While he died shortly thereafter, we have some witness anecdotes suggesting that he experienced a phantom limb: when Claude Monet (1840-1926) visited him and sat down on his bed, Manet violently shouted at him that he was just sitting on his (absent) leg, which provoked terrible pains. With its facts and mysteries, the subtle interaction between Manet's illness and his work output remains one of the most intriguing stories in neurology of art.
[Mh] MeSH terms primary: Ataxia/history
Paintings/history
Phantom Limb/history
Tabes Dorsalis/history
[Mh] MeSH terms secundary: Famous Persons
France
History, 19th Century
Humans
Male
[Pt] Publication type:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE
[Ps] Personal name as subject:Manet E
[Em] Entry month:1709
[Cu] Class update date: 170926
[Lr] Last revision date:170926
[Js] Journal subset:IM
[Da] Date of entry for processing:160720
[St] Status:MEDLINE
[do] DOI:10.1159/000447260


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