Reversal of syphilitic hydrocephalus with intravenous penicillin

Background: CSF shunting procedures are generally considered the fundamental therapy of syphilitic hydrocephalus. Methods: We followed up with CSF analysis and MR imaging a patient with progressive mental and gait disturbances and tetraventricular hydrocephalus due to tertiary syphilis who was treated for 14 days with high dose intravenous penicillin alone. Results: Clinical and CSF abnormalities resolved within a few months, whereas the hydrocephalus disappeared only 30 months after therapy. Conclusions: Before consideration of a CSF shunting procedure, a trial of high dose intravenous penicillin is warranted for patients with syphilitic hydrocephalus.