The neuro-ophthalmic manifestations of early neurosyphilis are diverse.
Early neurosyphilis results in vasculitis and vascular compromise, which
often presents as a stroke-like clinical finding.
Therefore, any of the
cranial nuclei and their pathways may be affected, which results in
isolated as well as complicated palsies of the third, fourth, and sixth
cranial nerves.
Abnormalities of the saccadic systems and smooth pursuit
systems may also occur.
Other neuro-ophthalmologic manifestations that
have been described include the superior orbital fissure syndrome that
arises from focal gummas, brainstem infarction, basilar meningitis,
homonymous hemianopia, chiasmal syndrome with bitemporal hemianopia,
cortical blindness, lateral medullary plate syndrome, Horner’s syndrome,
and internuclear ophthalmoplegia.
Late neurosyphilis may cause a
general paresis and tabes dorsalis.
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