Abstract:

Objective To assess the clinical presentations and treatment of neurosyphilis with mania as the first manifestation. Methods A retrospective study was performed. Clinical data on neurosyphilis patients with mania as the first manifestation collected from July 2009 to June 2010 were analyzed. Results Twenty cases of neurosyphilis were included in this study, which were all misdiagnosed as schizophrenia, anxiety, cerebral infarction, etc. All the patients had manic symptoms at onset, such as irritability, bad temper, impulsive behavior, disturbance in thinking, and so on. Some patients also suffered from a marked decrease in memory, calculation and cognitive ability. Rapid plasma reagin （RPR） test, Treponema pallidum hemagglutination （TPHA） test and cerebrospinal fluid （CSF） venereal disease research laboratory （VDRL） test were positive in all the patients. Varying degrees of symptomatic improvement was achieved after anti-syphilis and anti-psychotic treatment. CSF was retested in 13 patients 3 months after the end of treatment, and CSF VDRL titer decreased in 10 patients, remained unchanged in 2 patients, and turned negative in 1 patient. Conclusions Neurosyphilis lacks distinctive clinical characteristics. For patients with poor response to conventional antipsychotic therapy, neurosyphilis should be considered, and serology and cerebrospinal fluid tests for syphilis are warranted.