Browsing by Author "Roberts, M. C."

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    Psychiatric manifestations of neurosyphilis
    (Health & Medical Publishing Group, 1992) Roberts, M. C.; Emsley, R. A.
    To investigate referral patterns, initial diagnoses and clinical features of patients with neurosyphilis who present with psychiatric manifestations, records were kept of 21 such patients admitted to an acute psychiatric ward. In none of the 12 cases referred from primary care workers was the possibility of neurosyphilis considered. In only 3 cases was this diagnosis considered on admission to the psychiatric ward before serum serological test results were known. Commonest presenting symptoms were personality change (16 patients) and memory impairment (13 patients). Neurological signs or symptoms were also common, particularly absent pupillary reaction to light (5 patients) and buccolingual masticatory movements (5 patients). A positive serological test remains the single most important factor in identifying patients with neurosyphilis.
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    Screening for syphilis and neurosyphilis in acute psychiatric admissions
    (Health & Medical Publishing Group, 1992) Roberts, M. C.; Emsley, R. A.; Jordaan, G. P.
    The value of blood screening for syphilis and cerebrospinal fluid (CSF) screening for neurosyphilis in acute psychiatric admissions is assessed. Of 1296 patients, 248 (19%) had evidence of previous or current syphilis as shown by a positive Treponema pallidum haemagglutination test, and 68 (5,2%) had potentially treatable syphilis as shown by a positive Venereal Disease Research Laboratory (VDRL) titre. CSF examination was performed on 169 patients with a positive blood test. Seventeen (i.e. 1,3% of all patients included in the study) met our criteria for neurosyphilis. The best predictor for neurosyphilis was the presence of a reactive serum VDRL. However, it is recommended that all patients with a positive blood test and symptoms that could possibly be ascribed to neurosyphilis undergo CSF examination.
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    The usefulness of cerebrospinal fluid tests for neurosyphilis
    (Health & Medical Publishing Group, 1994) Russouw, H. G.; Roberts, M. C.; Emsley, R. A.; Joubert, J. J.
    To determine the usefulness of cerebrospinal fluid (CSF) tests for syphilis at a large academic hospital, clinical and laboratory data on 644 patients in whom such testing was requested over a 12-month period were analysed. In 198 cases (31%) the Treponema pallidum haemagglutination (TPHA) screening test could not be performed because of insufficient fluid. Thirty-eight of the remaining patients were diagnosed as having active neurosyphilis. Examination of 22 files of patients who had a positive TPHA and fluorescent treponemal antibody absorption (FTA-Abs) test together with a negative CSF Venereal Disease Research Laboratory (VDRL) test revealed that other CSF measures indicating disease activity (CSF protein, cells or IgG index) were not utilised optimally. In 10 (45%) of these patients neurosyphilis was not diagnosed despite either abnormal or incomplete CSF biochemical analysis, indicating that if the CSF VDRL is used as the sole marker for disease activity, some cases of neurosyphilis are likely to be missed.