Dementia paralytica may present diagnostic difficulties when routine serological test using a non-treponemal antigen is non-reactive. We present an illustrative demented patient who initially had negative VDRL test both in his serum and cerebrospinal fluid. However, the brain biopsy specimen showed active meningoencephalitis. By special staining technique, a spiral organism was found in the brain exhibiting morphology perfectly compatible with treponema pallidum. Later in the course, the VDRL became reactive in the blood but remained non-reactive in the cerebrospinal fluid. On the basis of the experience of other workers in the field and ours with this patient, we advise the use of FTA-ABS test as a screening procedure in patients with neurological problems of possible syphilitic origin. We urge further research in this field.
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↵2 Address for reprints: Dr. Hathaway, Department of Pathology, University of Alabama Medical Center, 1919 Seventh Avenue South, Birmingham, Alabama 35233, U.S.A.
↵1 This work was supported (in part) by a Special Fellowship 2-F11-1633-04 VSN from the National Institute of Neurological Diseases and Blindness, Public Health Service.
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