To analyze the clinical characteristics of neurosyphilis with cranial nerve involved as the main manifestation.

The clinical manifestation, laboratory findings, neuroimages features, treatment and curative effects of 20 neurosyphilis patients with anti-HIV negative were analyzed, retrospectively. The cranial nerves were impaired as the main performance in all the subjects.

Among the 20 cases, there were 13 males and 7 femals; the average age was (47.85 ± 12.99) years old; the median course was 9.5 (2.5, 33) months. Seventeen patients (85%) had acute onset, and their clinical manifestations varied with the involvement of cranial nerves. There was 17 cases (85%) with single cranial nerve damaged, 3 cases (15%) with two cranial nerves damaged, but no case with 3 or more cranial nerve damaged. Among the patients with single cranial nerve damaged, the frequency of the cranial nerve involved ranked optic nerve (5 cases, 25%), auditory nerve (5 cases, 25%), abducent nerve (4 cases, 20%), oculomotor nerve (2 cases, 10%) and trigeminal nerve (1 cases, 5%). The serum treponema pallidum particle assay (TPPA) and toluidine red unheated serum test (TRUST) were positive in all 20 patients. Routine and biochemical detection of cerebrospinal fluid were performed in 18 patients, among whom 15 (83.33%) cases had increased leukocyte count and 9 (83.33%) had elevated protein level; the white blood cells in cerebrospinal fluid were mainly monocytes. The responsible lesions were found by cranial magnetic resonance imaging (MRI) of 2 patients cranial MRI; of 5 patients were normal, however, abnormal signals associated with disease were found in their facial MRI. Sixteen patients underwent evoked potential examination, 8 cases (50%) of whom had abnormal evoked potential. Among the 20 patients, 18 cases were treated with penicillin, 1 case was treated with ceftriaxone, and 1 case was treated with doxycycline. The symptoms of 11 cases (55%) improved.

The clinical manifestations of neurosyphilis patients with cranial nerve impaired as the main manifestation were associated with involved cranial nerves. The diagnosis of this kind of neurosyphilis should focus on the comprehensive analysis, and combine the medical history and auxiliary examination. Early diagnosis and standard therapy could improve the prognosis.