Clinical and Laboratory Characteristics, Neuroimaging Alternations and Treatment Response of 25 HIV-Negative General Paresis Patients

Abstract

Purpose

General paresis is a common type of neurosyphilis featuring progressive cognitive deterioration. The lack of a golden standard of diagnosis and its nonspecific clinical manifestations resulted in a high rate of misdiagnoses. This study aims to investigate the clinical, laboratory and radiological presentations of general paresis and enrich its knowledge for timely diagnoses.

Patients and methods

The study collected hospitalized patients admitted for general paresis from September 2002 to November 2022. Their socio-demographical and medical status, clinical presentations, cognitive assessments, laboratory and radiographical manifestations and treatment information were collected retrospectively.

Results

A total of 20 males and 5 females were included. Patients’ ages ranged from 30 to 66 years (average 50.3 years). The average and median time for diagnosing general paresis was 14.1 months and 10.0 months respectively. The most frequent initial symptom is memory deterioration (68.0%). Impaired calculative ability and memory deterioration were the most frequent cognitive anomalies, as found in 50% and 45.4% of subjects during examination. The mean and median scores of MoCA was 16.7 and 17 respectively. Serological tests revealed positive TPPA for all patients and a median RPR titer at 1:64 positive. All CSF samples with TPPA and FTA-ABS results reported positivity. The MRI manifestations of general paresis include patchy or speckled hyperintensities (70.8%) and cerebral atrophy (45.8%). The most common lesioned sites in MRI were the ventricular and paraventricular area (50.0%) and temporal lobes (45.8%). For treatment, penicillin-based anti-syphilitic plans were adopted in 17 patients (68.0%).

Conclusion

The clinical features and radiological alternations of general paresis patients often exhibited diverse and nonspecific alternations. However, some specific clinical manifestations and auxiliary examinations can provide meaningful clues for the identification and differential diagnosis of this disease.

Keywords:

• neurosyphilis
• general paresis
• syphilis
• neuropsychiatric symptoms

Abbreviations

TP, Treponema pallidum; CNS, Central nervous system; AD, Alzheimer’s disease; PUMCH, Peking Union Medical College Hospital; TPPA, Treponema pallidum particle agglutination; RPR, Rapid plasma regain; CSF, Cerebrospinal fluid; MoCA, Montreal Cognitive Assessment.

Data Sharing Statement

Because of data availability policy of PUMCH and the private content in the original medical record, the original data of the study is unavailable.

Ethical Approval

This retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethical Review Board of Peking Union Medical Hospital (ethics number: S-K653). The committee determined that consent from study participants was not required because of the retrospective nature of this study, along with stringent measures implemented to ensure the privacy and confidentiality.

Author Contributions

Mingjuan Liu conceived and designed the study and drafted the manuscript. Hanlin Zhang acquired the data, analyzed and interpreted the result, and critically revised the manuscript. Mingli Li provided significant input in the study design, data analysis and interpretation. Jun Li contributed to the acquisition of data, analysis and interpretation, and critically revised the manuscript. Meiyi Tong, Jia Zhou, Yining Lan, Mengyin Wu, Yanfeng Li, Ling Leng, and Heyi Zheng also made important contributions to the study design, data acquisition, analysis and interpretation, and critical review of the manuscript. All authors have read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

National High Level Hospital Clinical Research Funding (2022-PUMCH-B-092) and Beijing College Student Innovation and Entrepreneurship Training Program (2023zglc06016).