Cognitive impairment: clinical presentation of an immunocompetent patient with neurosyphilis
Bibliographic record
Abstract
Case presentation: Patient R.P.S, male, 47 years old, previously diagnosed with depression. About two years ago, sought care with a headache, temporal and spatial disorientation, and cognitive impairment, evolving with inability to accomplish activities of daily living without assistance. The patient was diagnosed with syphilis (serologic VDRL 1/64) and received treatment for late latent stage, with benzathine penicillin G intramuscularly in 3 weekly doses. After treatment, the patient persisted with cognitive impairment and infatilized behavior. On May, 2024, was brought to the emergency care unit after first epileptic seizure with secondary generalization. There was no recurrence of seizure since admission. Montreal Cognitive Assessment (MoCA) was performed, with score 15/30. The initial brain computerized tomography was normal. The laboratory revealed syphilis rapid diagnostic test positive, serologic VDRL 1/32, anti-HIV negative, and reactive VDRL in cerebrospinal fluid. The patient underwent treatment with intravenous crystalline penicillin for 21 days. After therapy, his MOCA score was 19/30. He was discharged and referred to the Cognitive Neurology clinic. Discussion: Neurosyphilis can occur at any stage of syphilis. Clinical manifestation range from asymptomatic, meningeal, meningovascular, to tabes dorsalis and general syphilitic paresis. Recognizing the neurological manifestations is important, as the treatment differs from that of syphilis without neurological involvement. Failure to diagnose and inadequately treat neurosyphilis can cause severe and permanent damage to the patient. Without proper treatment, the infection can progress, resulting in severe neurological symptoms such as headaches, confusion, loss of vision, hearing, and motor control. The patient may develop dementia, paralysis, personality changes, and psychiatric problems. These complications can lead to a significant reduction in quality of life, inability to work, and increased dependence on medical care and social support. In extreme cases, untreated neurosyphilis can be fatal. Final comments: Neurosyphilis can be a diagnostic challenge due to its variety in clinical presentation, and it should be considered as a differential diagnosis in patients with cognitive impairment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".