• Syphilis.

Secondary stage is when you get meningovascular syphilis. If you have a 35-year-old person with a stroke, think meningovascular syphilis. In the secondary stage you can have a meningitis. It’s a subacute meningitis, catches cranial nerves very easily, just like TB. Second, third, sixth, all kinds of cranial nerves are caught. Subacute meningitis in a young person, the tempo is a little slow, keep syphilis in mind. The tertiary stage which comes five, six years after the primary exposure, the secondary stage comes about two or three years after exposure. That’s when you get meningitis and stroke. The tertiary stage comes after five or ten years. There are two disorders you need to remember. One, obviously is tabes dorsalis; shooting pain, proprioceptive loss, ataxia, bladder problem with Argyll-Robinson pupil.

  • Tabes dorsalis.

Charcot’s joints. Big destroyed swollen joints. Tabes dorsalis. GPI is general paralysis of the insane. Subacute or short chronic dementia. Personality change, dementia coming on over 4-6 months in a 45-year-old person. Rather than a 70-year-old person with two year dementia, which is Alzheimer’s. GPI is four, five, six months of dementia. Very important. They have motor findings; dysarthria, hip tremor, provigil. GPI.

  • Cysticercosis.
  • The fluid that the cyst has apparently is very irritating to the brain. In fact, people apparently die when you remove the cyst. So treat with praziquantel or albendazole. Occasionally you may need to shunt. If the patient just has seizures, give them seizure drugs.

    Slow viruses.

Kuru, New Guinea, Creutzfeldt-Jakob, dementia, myoclonus, basal ganglia problems. Maybe cortical blindness, maybe ataxia, periodic complexes. The CSF is normal. They die in about a year, at the most two. PML we talked about. JC virus, white matter. What does this do? Gertsmann’s-Strausler syndrome? What’s the main sign and symptom? Cerebellar ataxia, positive family history. So the differential diagnosis for Creutzfeldt-Jakob in a way is Gertsmann’s-Strausler. But look carefully for family history. SSPE: post-measles, younger people. The EEG complexes are high in amplitude but less frequent.

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