Neurosyphilis continues to have a significant incidence in the 21st century, especially in certain subpopulations. It has previously been reported that extrapyramidal features may accompany the more typical central neurosyphilitic manifestions of dementia, ataxia, psychosis, frontal deficits and Argyll-Robertson pupils. We report for the first time neurosyphilis presenting with relatively pure Parkinsonian clinical features.
A 53 year old man with gradual onset of bradykinesia and rigidity was found to have positive Treponemal serology and cerebrospinal fluid VRDL reaction. A major improvement followed antibiotic treatment but, over the subsequent fifteen years, the patient slowly deteriorated again in a manner consistent with idiopathic Parkinson's disease. A dopaminergic deficit was demonstrated on [1 2 3I]FP-CIT SPECT. This late second deterioration could indicate that the neurosyphilitic basal ganglial insult primed or accelerated development of idiopathic-like disease.
Blood test screening for syphilis is not routinely performed in patients presenting with Parkinsonism and so the true prevalence of neurosyphilitic aetiology is unknown. Given the options for treatment, such screening could be justified.