神经梅毒38例临床分析及文献复习

［摘要］　目的　探讨神经梅毒患者的临床特征、实验室检查、早期诊断、分型依据和治疗情况。方法　选择2004-09～2014-01江苏大学附属医院、镇江市第一人民医院和江苏大学附属第四人民医院收治的38例神经梅毒患者资料进行回顾性分析。结果　38例患者中男28例，女10例，年龄1 d～75岁，平均51.1岁，神经梅毒患者中间质型10例(脑膜血管梅毒8例，脊髓膜血管梅毒1例，脑膜神经梅毒1例)，主质型22例(麻痹性痴呆14例，脊髓痨8例)，视神经损害2例，无症状型神经梅毒3例，先天性神经梅毒1例；血清、脑脊液快速血浆反应素试验（RPR）及梅毒螺旋体特异抗体测定（TPPA）均阳性，部分患者脑脊液检查显示脑脊液蛋白质含量升高和白细胞计数升高(以单核细胞为主)。除3例放弃治疗外，35例经治疗后好转的患者血清及脑脊液抗体滴度均有不同程度降低，脑脊液白细胞数、蛋白量均降至正常。结论　神经梅毒可防可治，脑脊液梅毒诊断试验是神经梅毒诊断的重要依据，同时需结合临床表现及其他检查进行综合分析，及时正确治疗能够控制病情。     

脑膜血管型神经梅毒的诊治(附4例报道及文献复习)

目的分析脑膜血管型神经梅毒的临床表现、实验室检查和神经影像学检查特点及其治疗和预后,提高对该病的诊治水平。方法对我院收治的4例脑膜血管型神经梅毒患者的临床资料、实验室检查、神经影像学检查结果及诊治经过进行回顾性分析。结果 4例患者中3例男性,1例女性,均以脑卒中样表现起病,脑血管病危险因素较少,影像学检查无特异性,血清及脑脊液血梅毒螺旋体明胶凝集试验(TPPA)和快速血浆反应素试验(RPR)阳性以确诊,大剂量青霉素治疗预后较好。结论脑膜血管型神经梅毒临床表现及神经影像学检查无特异性,容易误诊,对没有明确病因或病因较少的脑梗死患者,及早进行梅毒血清学实验和脑脊液检查,大剂量青霉素治疗有效。     

20例HIV抗体阴性神经梅毒患者的临床分析

目的总结神经梅毒的临床特征以提高对其疾病的认识。方法回顾性分析了20例艾滋病病毒(HIV)抗体阴性的神经梅毒患者的临床表现、实验室检查和影像学特点。结果20例神经梅毒患者中,无症状神经梅毒2例,间质型神经梅毒9例,实质型神经梅毒8例(麻痹性痴呆5例和脊髓痨3例),特殊类型神经梅毒(多颅神经损害)1例。实验室检查示,63.16%的患者脑脊液快速血浆反应素试验(CSF-RPR)阳性,100%的梅毒螺旋体抗原凝集试验(CSF-TPPA)阳性,脑脊液蛋白和细胞数增高分别为75%和50%;头颅CT和MRI表现脑萎缩、梗死或脱髓鞘病变。结论神经梅毒的临床表现与其分型密切相关,实质型神经梅毒应引起重视;TPPA或许在神经梅毒脑脊液检测中可以使用,但神经梅毒的诊断应结合临床表现及辅助实验检查综合分析。     

神经梅毒10例临床分析

目的分析神经梅毒的临床特征,探讨其诊断、治疗及预后。方法回顾性分析了我院2013年7月~2017年1月收治的10例神经梅毒病例。结果 10例患者中,其中2例女性,8例男性。10例患者在确诊神经梅毒前存在误诊。所有患者的脑脊液白细胞数、蛋白均有所升高,血清及脑脊液TPPA及RPR均为阳性。除1例患者失访外,其他9例患者临床症状均有明显改善。结论神经梅毒发病形式多变,易出现误诊情况,其诊断需结合临床表现、血清TPPA和RPR、脑脊液TPPA和RPR、脑脊液白细胞数和蛋白及影像学检查,早期诊断、早期治疗可改善预后。     

神经梅毒9例临床分析

目的探讨神经梅毒临床表现、实验室检查、影像学特征、诊断、治疗及预后。方法回顾分析9例神经梅毒临床资料。结果本组病例共9例,男5例,女4例,年龄38～76岁。脑膜型3例,脑膜血管型1例,麻痹性痴呆4例,脊髓痨1例。颅脑MRI检查4例有脑萎缩,1例脑膜增强,2例有脑梗死。治疗后3例痊愈,5例好转,1例无效。治疗后血清和脑脊液梅毒螺旋体凝胶试验（TPPA）转阴率低于反应素实验（RPR）。结论神经梅毒表现多样,误诊率高,临床表现与分型密切相关,实验室及影像检查是诊断重要依据。     

神经梅毒的临床特征及诊治分析

目的探讨神经梅毒的临床、神经影像学和实验室检查特征及其治疗和预后,以提高对该病的诊治水平。方法对本院收治的符合神经梅毒诊断标准的18例神经梅毒患者的临床资料、实验室检查、MRI结果及诊治过程进行回顾性分析。结果临床以间质型梅毒,尤其以脑膜血管梅毒常见,临床表现缺乏特异性;血清梅毒螺旋体凝集试验特异性较高,而脑脊液的阳性率低于血清;头部MRI以梅毒树胶肿表现典型;治疗上除梅毒树胶肿需手术切除外,余类型首选青霉素治疗,有效率93％（14115例）。结论神经梅毒的临床表现及神经影像学无特异性,易误诊,血清或（和）脑脊液梅毒抗体阳性即可确诊,青霉素仍为有效的首选治疗药物。     

未经治疗梅毒患者脑脊液检测的意义

目的　观察艾滋病病毒 (HIV)阴性、未经治疗、且无神经损害临床表现的梅毒患者的脑脊液常规及梅毒抗体的检测情况 ,并探讨这些指标的诊断意义。方法　对 36例未经治疗且无神经系统临床表现的梅毒 (其中二期16例 ,隐性 2 0例 )患者脑脊液进行脑脊液常规、梅毒暗视野检查、聚合酶链反应 (PCR)及脑脊液梅毒抗体试验、梅毒血清快速反应素试验 [(RPR)、IgM、梅毒参比试验 (VDRL)、荧光密螺旋体抗体 (TPPA)、梅毒螺旋体明胶颗粒凝集试验 (FTA Abs) ]检测。结果　在所检测的 36例梅毒患者脑脊液中 ,常规检测发现 2 4例 (6 6 6 7% )蛋白升高 ,11例 (30 6 % )葡萄糖升高 ,未发现红细胞和白细胞 ;有 19例 (5 2 78% )梅毒患者脑脊液存在≥ 1种梅毒抗体。其中 6例 (16 7% )VDRL阳性 ,13例 (36 39% )FTA Abs阳性 ,14例 (38 33% )TPHA阳性 ,RPR、IgM、TP PCR及梅毒暗视野检查均阴性 ;二期和隐性梅毒各项指标检测结果之间差异无显著的统计学意义 (P >0 0 5 ) ;而脑脊液VDRL、FTA Abs、TPPA三种检测结果之间差异有显著的统计学意义 (P <0 0 5 )。结论　未经治疗的梅毒患者其脑脊液存在异常 ,这些异常的结果表明部分未经治疗的梅毒患者存在无症状神经梅毒。     

神经梅毒12例临床分析

目的探讨神经梅毒的临床特点、诊断和治疗。方法对12例神经梅毒患者的临床资料进行回顾性分析。结果12例神经梅毒患者中麻痹性痴呆6例,脑血管型梅毒3例。脑膜型梅毒2例,脊髓痨1例;血清快速血浆反应素试验（RPR）、梅毒螺旋体抗原凝集试验（TPPA）阳性率为100％,脑脊液-TPPA（CSF-TPPA）阳性率为100％．CSF-RPR阳性率为75％;脑电图和颅脑CT或MRI异常缺乏特异性;大剂量青霉素G治疗安全有效。结论神经梅毒临床表现复杂多样,诊断主要根据临床特点,CSF和血清RPR、TPPA对诊断有重要价值,青霉素G是首选的治疗药物。     

神经梅毒的临床特征与诊断分析典型病例二例

神经梅毒早期误诊率高,确诊需依据病史、临床表现及血清和脑脊液的梅毒抗体检测。本文报道了2例神经梅毒患者,分析其临床特征,旨在为早期诊断提供依据。     

脑脊液免疫球蛋白作为神经梅毒诊断和愈后判断指标的研究

目的探讨脑脊液免疫球蛋白对神经梅毒的诊断和愈合判断的价值。方法回顾36例多次住院神经梅毒临床和实验室检查等资料,采用SPSS 17.0进行统计分析。结果36例神经梅毒患者中无症状神经梅毒13例,麻痹性痴呆11例,脑膜血管梅毒5例,脊髓痨5例,脑膜神经梅毒2例。初次检查脑脊液免疫球蛋白(Ig)IgG、白细胞、IgM、IgA和蛋白升高分别为35例(97.2%)、30例(83.3%)、29例(80.6%)、26例(72.2%)、25例(69.4%)。血清甲苯胺红不加热试验(TRUST),脑脊液TRUST、IgA、IgG、IgM、白细胞、蛋白皆较治疗前降低,差异有统计学意义(P<0.05)。结论脑脊液中的免疫球蛋白可以作为神经梅毒的诊断和愈后判断的新指标。     

A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals.

To compare intravenous (iv) ceftriaxone and penicillin G as therapy for neurosyphilis, blood and CSF were collected before and 14-26 weeks after therapy from 30 subjects infected with human immunodeficiency virus (HIV)-1 who had (1) rapid plasma reagin (RPR) test titers >/=1&rcolon;16, (2) reactive serum treponemal tests, and (3) either reactive CSF-Venereal Disease Research Laboratory (VDRL) tests or CSF abnormalities: (a) CSF WBC values >/=20/microL or (b) CSF protein values >/=50 mg/dL. At baseline, more ceftriaxone recipients had skin symptoms and signs (6 [43%] of 14 vs. 1 [6%] of 16; P=.03), and more penicillin recipients had a history of neurosyphilis (7 [44%] of 16 vs. 1 [7%] of 14; P=.04). There was no difference in the proportion of subjects in each group whose CSF measures improved. Significantly more ceftriaxone recipients had a decline in serum RPR titers (8 [80%] of 10 vs. 2 [13%] of 15; P=. 003), even after controlling for baseline RPR titer, skin symptoms and signs, or prior neurosyphilis were controlled for. Differences in the 2 groups limit comparisons between them. However, iv ceftriaxone may be an alternative to penicillin for treatment of HIV-infected patients with neurosyphilis and concomitant early syphilis.     

Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features

OBJECTIVE: To define clinical and laboratory features that identify patients with neurosyphilis. METHODS: Subjects (n=326) with syphilis but no previous neurosyphilis who met 1993 Centers for Disease Control and Prevention criteria for lumbar puncture underwent standardized history, neurological examination, venipuncture, and lumbar puncture. Neurosyphilis was defined as a cerebrospinal fluid (CSF) white blood cell count >20 cells/ microL or reactive CSF Venereal Disease Research Laboratory (VDRL) test result. RESULTS: Sixty-five subjects (20.1%) had neurosyphilis. Early syphilis increased the odds of neurosyphilis in univariate but not multivariate analyses. In multivariate analyses, serum rapid plasma reagin (RPR) titer > or =1 : 32 increased the odds of neurosyphilis 10.85-fold in human immunodeficiency virus (HIV)-uninfected subjects and 5.98-fold in HIV-infected subjects. A peripheral blood CD4+ T cell count < or =350 cells/ microL conferred 3.10-fold increased odds of neurosyphilis in HIV-infected subjects. Similar results were obtained when neurosyphilis was more stringently defined as a reactive CSF VDRL test result. CONCLUSION: Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis.     

梅毒血清复发患者脑脊液IFN-γ等指标检测结果分析

目的探讨梅毒血清复发与神经梅毒之间的关系,同时从细胞免疫学角度对梅毒血清复发的发生机制进行研究。方法对20例符合梅毒血清复发诊断的患者行腰穿抽取脑脊液,进行常规、生化、血浆快速反应素试验（RPR）及梅毒螺旋体明胶凝集试验（TPPA）检测;采用双抗体夹心酶联免疫吸附试验（ABC-ELISA）分别检测血清复发组、RPR阴转组（20例）和正常人群组（20例）血清中γ-干扰素（IFN-γ）的含量,以及血清复发组脑脊液中IFN-γ的含量。结果在20例血清复发患者中,有5例神经梅毒（25.0%）。血清复发组患者血清IFN-γ水平明显低于正常对照组、RPR阴转组,差异均有统计学意义（P〈0.01,P〈0.01）。结论神经系统受累可能是梅毒血清复发的原因之一;梅毒血清复发患者的细胞免疫功能受到抑制。     

Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis.

PURPOSE: A prospective study was done to determine the prevalence of confirmed neurosyphilis (cerebrospinal fluid [CSF] Venereal Disease Research Laboratory [VDRL]-reactive) in human immunodeficiency virus (HIV)-infected patients with latent syphilis (reactive serum rapid plasma reagin [RPR] and microhemagglutination-Treponema pallidum [MHA-TP]). PATIENTS AND METHODS: All HIV-infected patients seen for their first visit at the Los Angeles County/University of Southern California Medical Center AIDS Clinic from June through December 1990 were screened for latent syphilis. Those with reactive serum RPRs and MHA-TPs who had not received recent (within 6 months) therapy for syphilis were offered diagnostic CSF sampling. RESULTS: A total of 312 patients were screened, of whom 71 (22.8%) had reactive serum RPRs and MHA-TPs. Thirty-three of these patients (47%) had diagnostic CSF sampling (26 refused lumbar puncture or were lost to follow-up; 12 had had recent therapy for syphilis and thus did not have CSF sampling). Among the 33 patients who had CSF sampling, 20 (60.6%) had normal CSF profiles (white blood cell count less than 8/mm3; protein less than 0.60 g/L; glucose greater than 2.8 mmol/L) and nonreactive CSF VDRLs. Ten of the 33 patients (30.3%) had abnormal CSF profiles and nonreactive CSF VDRLs, and three of 33 (9.1%) had reactive CSF VDRLs. CONCLUSIONS: Asymptomatic neurosyphilis was found in 9.1% of our patient population undergoing CSF sampling, giving a 1.0% prevalence of CSF VDRL-reactive neurosyphilis in the population we screened. The abnormal CSF findings may have been due to either nonreactive CSF VDRL neurosyphilis, central nervous system infection with HIV, or infection with some unrecognized agent.     

Clinical characteristics,diagnosis, and predictors of neurosyphilis patients with human immunodeficiency virus co-infection: A retrospective study at infectious diseases hospitals in two cities of China

This study aimed to compare between the clinical and laboratory characteristics of neurosyphilis and those of syphilis in human immunodeficiency virus (HIV) positive and explore the risk factors associated with the occurrence of neurosyphilis in the HIV infected.In-patients diagnosed with HIV and syphilis co-infection who underwent a lumbar puncture and completed cerebrospinal fluid (CSF) examination were divided into neurosyphilis group and syphilis group. The demographic characteristics, symptoms and signs, and laboratory tests of the 2 groups were comparatively analyzed. Logistic regression analysis was used to explore the risk factors associated with the occurrence of neurosyphilis.Among 81 patients, 33 patients were assigned to the neurosyphilis group, and 48 to the syphilis group. There were no significant differences in the age, gender, marital status, acquired immunodeficiency syndrome course, opportunistic infections, serum HIV viral load, and history of syphilis treatment. The difference in HIV transmission route between the 2 groups was statistically significant (P = .010), and the patients from the neurosyphilis group were mainly infected via heterosexual contact. The proportion of serum toludine red unheated serum test (TRUST) titer ≥1:16 in the neurosyphilis group were 78.8%, which was significantly higher compared to the syphilis group (48.9%). The level of CSF white blood cell count, CSF protein, and CSF HIV viral load in the neurosyphilis group were significantly higher than those of the syphilis group. The proportion of patients with neurological symptoms and signs in the neurosyphilis group was significantly higher compared to the syphilis group (P < .001). Multivariate logistic regression analysis showed that heterosexual contact transmission route, not received antiretroviral therapy, lower CD4 cell count and higher serum TRUST titer, untreated with syphilis, and neurological symptoms and signs were risk factors associated with the occurrence of neurosyphilis.The serum TRUST titer, CSF white blood cell count, CSF protein level, CSF HIV viral load, and the percentage of neurological symptoms and signs in the neurosyphilis group were higher. Heterosexual transmission route, not received antiretroviral therapy, and untreated with syphilis prompted the possibility of neurosyphilis occurrence.     

Serum TRSUT Titer ≥1:16 Is a Predictor for Neurosyphilis Among HIV-Infected Patients With Concurrent Syphilis and No Neurological Symptoms

Investigating the predictors for lumbar puncture to diagnose the asymptomatic neurosyphilis among HIV and syphilis co-infected patients in Shanghai, China.Respectively, screening the medical records from August 1, 2009 to June 30, 2015. Those HIV-infected patients with concurrent syphilis who had received lumbar puncture were selected and their clinical and demographic data were recorded. Participants comprised symptomatic and asymptomatic patients. The latter ones could be further divided into 3 groups: late syphilis, early syphilis with anti-syphilis treatment failure, and early syphilis with serum toludine red unheated serum test (TRUST) ≥1:32. Both syphilis stage and anti-syphilis treatment effect were defined by common criteria, and syphilis of unknown duration was considered as late syphilis. Asymptomatic neurosyphilis was defined as neurosyphilis without neurological symptoms such as headache, cognitive dysfunction, motor deficits, auditory or ophthalmic abnormalities, and stroke. Neurosyphilis was defined as reactive cerebrospinal fluid (CSF) TRUST and/or CSF white blood cell >20 cells/μL without other reasons. Mann–Whitney test and Fisher''s exact test were used for analyzing the difference between neurosyphilis and non-neurosyphilis group. Logistic regression test was performed to analyze the risk factors for neurosyphilis.In total, 170 participants were collected, and the rate of neurosyphilis was 32.35%. Among all the 105 participants without neurological symptoms, 80 patients were with late syphilis and 25 were with early syphilis. Among the early syphilis patients, 23 had a TRUST ≥1:32 and the other 2 experienced an anti-syphilis treatment failure. The differences of clinical and demographic variables between neurosyphilis and non-neurosyphilis group were not statistically significant except the serum TRUST titer (P < 0.01). From HIV/syphilis co-infected patients with or without neurological symptom, those who had neurological symptoms, CD4 <350 per μL and serological TRUST titer ≥1:16 were 4.9-fold (95% confidence interval [CI]: 2.37–10.31), 4.3-fold (95% CI: 1.17–15.78), and 4.1-fold (95% CI: 1.58–10.76), respectively, more likely to be diagnosed with neurosyphilis. Asymptomatic patients whose serum TRUST titer ≥1:16 were 8.48-fold (95% CI: 1.08–66.63) more likely to have asymptomatic neurosyphilis.Among asymptomatic HIV-infected patients with late syphilis or early syphilis experienced an anti-syphilis treatment failure, those who have a serum TRUST titer ≥1:16 are suggested to perform lumbar puncture in order to avoid delayed diagnosis and the occurrence of severe sequelae of syphilis.     

Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus.

OBJECTIVE: To evaluate the effect of ceftriaxone in treating latent syphilis or asymptomatic neurosyphilis in patients infected with the human immunodeficiency virus (HIV). DESIGN: Follow-up study of patients treated at two HIV-based clinics during 16 months from 1989 to 1991. PATIENTS: Patients were those in whom a clinical diagnosis of latent syphilis or asymptomatic neurosyphilis was made, who received all recommended doses of antimicrobial therapy, and who returned for follow-up visits for 6 or more months. RESULTS: Forty-three patients were treated with ceftriaxone, 1 to 2 g daily for 10 to 14 days. Thirteen underwent lumbar puncture before treatment; 7 (58%) had documented neurosyphilis (pleocytosis in 5, elevated protein levels in 6, VDRL reactive in cerebrospinal fluid [CSF] in 7), and 6 had documented latent syphilis (entirely normal CSF). The remaining 30 were said to have presumed latent syphilis. There was no relation between the diagnosis and the selected dosage of ceftriaxone. Response rates were similar in those who had documented neurosyphilis and documented or presumed latent syphilis. Overall, 28 patients (65%) responded to therapy, 5 (12%) were serofast, 9 (21%) had a serologic relapse, and 1 (2%) who experienced progression to symptomatic neurosyphilis was a therapeutic failure. Thirteen patients received benzathine penicillin for presumed latent syphilis; results were similar to those observed after ceftriaxone therapy, with 8 (62%) responders, 1 (8%) serofast, 2 (15%) relapses, and 2 (15%) failures. CD4 cell counts in responders were not different from those who failed to respond. CONCLUSIONS: Even in the absence of neurologic symptoms, half of the HIV-infected persons who have serologic evidence of syphilis may have neurosyphilis. Although ceftriaxone achieves high serum and CSF levels, 10 to 14 days of treatment with this drug were associated with a 23% failure rate in HIV-infected patients who had latent syphilis or asymptomatic neurosyphilis. Three doses of benzathine penicillin did not have a significantly higher relapse rate and may provide appropriate therapy, at least for documented latent syphilis in persons co-infected with HIV. Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients.     

卡介菌多糖核酸对梅毒血清固定患者细胞免疫功能的影响

目的探讨卡介菌多糖核酸对梅毒血清固定患者细胞免疫功能的影响。方法将32例梅毒血清固定患者分为两组,对照组14例,用头孢曲松钠治疗;实验组18例,在头孢曲松钠治疗基础上加用卡介菌多糖核酸。治疗前后对患者用快速血浆反应素环状卡片试验（RPR）进行检测,并使用流式细胞仪检测外周血CD4＋、CD8＋T淋巴细胞、Th1、Th2和NK细胞,使用酶联免疫吸附试验（ELISA）检测白细胞介素（IL）-2、IL-4、IL-10、IL-12水平。结果实验组治疗后,CD4＋T淋巴细胞、Th1细胞和CD4＋/CD8＋T淋巴细胞、Th1/Th2、IL-12较治疗前明显增高,IL-10明显降低,差异有统计学意义（P〈0.05,0.01,0.05,0.05,0.05,0.05）。CD8＋T淋巴细胞、Th2、NK细胞、IL-2、IL-4等改变不明显,差异无统计学意义。治疗结束后,实验组有5例RPR转阴,阴转率27.8%;对照组有2例RPR转阴,阴转率14.3%,两组RPR阴转率差异无统计学意义。结论卡介菌多糖核酸能提高Th1的表达,改善Th1/Th2失衡,提高机体免疫功能,可作为梅毒血清固定患者的辅助治疗药物,但其实际效果仍有待进一步证实。     

384例性病门诊就诊者荧光梅毒螺旋体抗体吸附试验结果分析

目的对384例荧光梅毒螺旋体抗体吸附试验（FTA_ABs）检测结果进行分析,更好地为临床提供梅毒诊断的依据。方法对2012年确诊梅毒并经FTA—ABS检测为阳性的384例患者的血清,同时用梅毒螺旋体明胶颗粒凝集法（TPPA）和酶联免疫吸附试验（ELISA）进行复核检测,并对其中的40例患者进行脑脊液FTAABS检测。结果384例FTAABS检测确诊的阳性病例中,梅毒抗体IgG、IgM同时阳性的59例（占15．4％）,抗体IgG阳性IgM阴性的325例（占84．6％）。40例脑脊液中抗体IgG阳性的12例,未见抗体IgM阳性。梅毒合并感染HIV的患者有29例（占7．6％）,其中RPR滴度〉1：8有21例（72．4％）。单纯梅毒感染的355例（92．4％）,其中RPR滴度〉1：8有97例（27．3%）。结论FTAABS试验敏感性和特异性高,值得在临床中推广。     

Serum and cerebrospinal fluid profiles for syphilis in Thai patients with acute ischaemic stroke

The diagnosis of neurosyphilis is complicated in elderly patients who have cerebrovascular risk factors and present with ischaemic stroke. We performed an analysis of serum and cerebrospinal fluid (CSF) profiles for neurosyphilis in acute stroke patients, particularly in those with atherosclerotic risk factors. In sera, the rapid plasma reagin (RPR) test and Treponema pallidum haemagglutination assay (TPHA) were used. In CSF, the RPR and fluorescent treponemal antibody-absorption tests were used together with CSF white blood cell (WBC) count and protein level. Baseline characteristics, including atherosclerotic risk factors, severity of stroke and computed tomography brain scan images were collected. Of the total 284 patients, 24 (8.4%) had TPHA-positive sera, from which 29.2% had a positive CSF for syphilis. Seven stroke patients (2.5%), with a mean age of 65.7 years, were diagnosed with symptomatic neurosyphilis, and 71% of them had atherosclerotic risk factors. Most symptomatic patients (85.7%) had CSF WBCs>20 cells/mm(3), with a mean of 98.6 ± 136.0 versus 3.2 ± 7.3 in non-neurosyphilitic patients (P = 0.0009). Less than 50% of the symptomatic patients had CSF protein levels >50 mg/dL, and the protein levels of neurosyphilitic and non-neurosyphilitic groups were not significantly different, with means of 52.0 ± 12.9 and 51.8 ± 15.9 mg/dL, respectively. There were no significant differences in age and stroke severity. Interpretation of CSF findings, particularly of CSF WBC counts and protein levels, must be appropriate to ascertain true symptomatic neurosyphilis cases and to reduce false-positive diagnoses, particularly in countries with a high prevalence of T. pallidum infection.