Parkinsonism-Plus Syndrome Secondary to Neurosyphilis: Case Report and Literature Review.

BACKGROUND/OBJECTIVE: Neurosyphilis can be associated with a variety of clinical manifestations. There are only a few cases of neurosyphilis associated with parkinsonism-plus syndromes (PPSs) that have been reported in the literature. We describe a case of an elderly woman who presented with abnormal gait and progressive visual disturbance, probably secondary to neurosyphilis.

METHODS: Literature search was performed in Embase, Google Scholar, Medline, Scielo, and ScienceDirect using a set of terms that included parkinsonism, tremor, and syphilis.

CASE REPORT: A 64-year-old female was admitted because of vision problems, gait disturbances, and cognitive impairment. The neurological examination revealed bradykinesia, rigidity, and rest tremor. The pupils were bilaterally small and reacted in size to a near object but did not constrict when exposed to bright light. The conjugate eye movements showed a defective downward gaze. On neuropsychological examination, the mini-mental state exam showed a moderate cognitive impairment. Reduced phonemic fluency was observed. A positive serum venereal disease research laboratory (VDRL) test was noted. A cerebrospinal fluid analysis showed positive VDRL. Brain and cervical spine magnetic resonance imaging was normal. An electro-encephalogram showed diffused slow waves. Penicillin G was started. Six months after, the patient had a full recovery of her conjugate eye movements and cognitive functions. Upon further questioning, the patient reported no response with a levodopa attempt.

CONCLUSIONS: To the authors' knowledge, two individuals developed progressive supra-nuclear palsy (PSP), and one presented corticobasal degeneration (CBD), probably associated with neurosyphilis. This is the second case to document the occurrence of a progressive supra-nuclear palsy because of syphilis.