1/5. neurosyphilis.We describe the case of a young woman with a rapid deterioration in her cognitive status and physical functioning. An extensive laboratory and radiologic evaluation confirmed the diagnosis of neurosyphilis. Despite the reemergence of syphilis with the acquired immunodeficiency syndrome (AIDS) epidemic, neurosyphilis is often neglected in the differential diagnosis of patients with aseptic meningitis and mental status changes who are negative for the human immunodeficiency virus (hiv). The high mortality rateassociated with delay in recognition, diagnosis, and treatment of neurosyphilis obligates its inclusion in the differential of young patients with cognitive decline.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Nonmedical complications of diagnostic workup for dementia [clinic conference]Testing for patients presenting with dementias can lead to diagnosis of disorders that can contribute to cognitive dysfunction, and to improvement, stabilization, or slowed deterioration in some demented patients. However, possible benefits must be balanced against possible costs. The present recommendations for workup of patients with dementia includes some tests with only marginal benefits, and a more limited workup may be as effective. This case demonstrates how important it is to be sensitive as well to possible effects on family relationships of demented patients. When we evaluate and treat demented patients, the dependence of the demented patient on the caregiver and the emotional and physical stresses experienced by many caregivers make it important to consider the patient and caregiver as a system vulnerable to many potential risks.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. The asymptomatic patient with a positive VDRL test.Although VDRL and RPR tests are excellent screens for syphilis, false-positive reactions do occur. A positive VDRL or RPR test must be confirmed with an FTA-ABS test. patients with positive serologic tests should have a thorough physical examination to determine the stage of syphilis. A patient with a low-titer VDRL or RPR may have active disease and may require lumbar puncture to rule out neurosyphilis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. neurosyphilis in community mental health clinics: a case series.Although the incidence of general paresis of the insane, which accounted for 10%-15% of psychiatric admissions in the past, decreased dramatically following the introduction of antibiotics, new cases of late neurosyphilis are beginning to appear. Five cases are presented to underscore the importance of periodic physical examinations and serologic screening in outpatient community mental health clinics.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Electroconvulsive treatment of depression associated with neurosyphilis.The authors describe a 67-year-old woman with nontabetic parenchymatous neurosyphilis associated with an affective disorder. It was not possible clinically to distinguish the relative contributions of psychiatric and neurologic etiologies to the patient's depressive and delusional symptoms. ECT proved effective for this patient, who might have otherwise been considered a treatment failure. The authors argue that the signs and symptoms of severe affective disorder should be treated if the presumed physical illness does not respond to therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |