Syphilis is a contagious, systemic disease caused by the slender, spiral organism, Treponema pallidum. The disease encompasses sequential clinical stages and years of latency. The condition is a form of neurosyphilis in which the meninges and vascular structures of the brain and spinal cord are involved. The condition may be localized or general.

The Treponema pallidum is identified by a dark-field microscope or fluorescent techniques. The organism cannot survive for long periods outside the human body. The condition is associated with the late stage of syphilis (see Diagnostic Code: 6310 Syphilis).

Manifestations of meningovascular syphilis characterized by brain involvement include: headache; dizziness; poor concentration; exhaustion; difficulty sleeping; neck stiffness; and blurred vision. In addition, there may be mental confusion; papilledema; aphasia; and hemiparesis or hemiplegia. Pupil abnormalities and cranial nerve palsies may also be present indicating basilar meningitis (see Diagnostic Code: 8019 Meningitis). The pupils may be irregular with poor light and accommodation (Argyll Robertson pupil). There may also be sudden, relaxed paraplegia and loss of sphincter control. If the large vessels are involved, there may be a stroke (CVA). Signs and symptoms of syphilis (see Diagnostic Code: 6310 Syphilis) may also be present.

Diagnostic tests for syphilis include: a clinical history and physical examination; serologic tests; investigations of sexual contacts; and, if appropriate, dark-field examination of fluids from lesions. Cerebrospinal fluid (CSF) tests and x-ray examinations may also be done. Serologic tests for syphilis (STS) aid in diagnosing syphilis and other related treponemal diseases.

Treatment may include the administration of antibiotics, antipsychotics and an analgesic. Patients under treatment are observed for the Jarisch-Herxheimer reaction.

There may be repeated tests performed on CSF. There may also be progression of sclerosis of the posterior columns of the spinal cord (see Diagnostic Code: 8015 Tabes dorsalis). Neurosyphilis, involving essential parts of the neurological system, generally affects patients in their 40s or 50s. The condition is manifested by progressive deterioration in behavior, and may mirror a psychiatric illness or Alzheimer's disease. Convulsions, difficulty communicating (verbally or otherwise), or transient weakness on one side of the body may occur. Irritability, difficulty in concentrating, deterioration of memory, defective judgment, headache, insomnia, or fatigue and lethargy more commonly appear. The patient's hygiene and grooming may deteriorate. Emotional instability, resulting in lack of strength, depression, and delusions of grandeur with lack of insight, may occur.

• None.

• It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses.

• Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating disability from the conditions in the preceding sentence refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances.  38 CFR 4.120

• With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves” 38 CFR 4.124a