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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Neuro-Ophthalmology
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1472274
This article is part of the Research Topic Elucidating the Relationships between Pupil Size and Neural and Autonomic Functions View all 5 articles

Ocular findings in neurosyphilis: a retrospective study from 2012 to 2022

Provisionally accepted
Huanhuan Cheng Huanhuan Cheng *Haocheng Zhu Haocheng Zhu *Gang Shen Gang Shen Yaqi Cheng Yaqi Cheng Jiao Gong Jiao Gong Juan Deng Juan Deng *
  • Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

The final, formatted version of the article will be published soon.

    PURPOSE: To investigate the ocular manifestations in patients with neurosyphilis and their association with general indexes. METHODS: This retrospective study was conducted in patients hospitalized for neurosyphilis from 2012 to 2022. Clinical manifestations, laboratory tests, brain MRI and ocular examinations were reviewed and analyzed. RESULTS: A total of 106 neurosyphilis patients were included and 10 patients had ocular signs as the initial presentation. The most common main complaint was reduced vision (6/10) followed by diplopia (2/10) and ptosis (2/10). The reasons for vision loss were optic neuropathy (4/6) and posterior uveitis (2/6) with all 6 patients showing optic nerve involvement. 29 (27.4%) patients had pupil abnormalities. Lumbar puncture was performed in all 106 patients and 101 (95.3%) patients had abnormal cerebrospinal fluid (CSF) findings suggesting central nervous involvement. The median white blood cell count of CSF in patients with pupil abnormalities was significantly higher than that in those without pupil abnormalities (14.0 vs 6.0 cells/μl, P=0.037). In addition, patients with abnormal pupillary light reflex (PLR) were more likely to have multiple brain lesions than those with normal PLR (77.3% vs 29.2%, P<0.001). CONCULSION: Optic nerve involvement is the main cause for vision loss in neurosyphilis. Patients with optic neuropathy or posterior uveitis should be arranged prompt diagnostic workup for syphilis. Pupil abnormality can serve as an indicator for more severe CSF and MRI findings.

    Keywords: Neurosyphilis, pupil abnormalities, Pupil light reflex (PLR), Ocular syphilis, optic neuropathy

    Received: 29 Jul 2024; Accepted: 30 Oct 2024.

    Copyright: © 2024 Cheng, Zhu, Shen, Cheng, Gong and Deng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Huanhuan Cheng, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Haocheng Zhu, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Juan Deng, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

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