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Seronegative dementia paralytica: report of a case
  1. L. Ch'ien,
  2. B. M. Hathaway2,
  3. C. W. Israel
  1. Division of Neurology, Department of Medicine, University of Alabama Medical Center, Florida, U.S.A.
  2. Department of Pathology, University of Alabama Medical Center, Florida, U.S.A.
  3. Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, U.S.A.


    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.