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The 2001 American Academy of Neurology Practice Parameter on diagnosis of dementia recommends screening for syphilis only if the patient has risk factors, has prior syphilitic infection, or resides in an area with a high prevalence (southern and midwestern United States).1 In contrast, screening for syphilis was part of the initial evaluation in the1994 guidelines.2 The new recommendations reflect a decline in cases of syphilis since the 1980s, and many sources of a false positive rapid plasma reagin (RPR).1 The guidelines do not address false negatives.
Case report.
Approximately 4 months prior to presentation, a 57-year-old right-handed man developed intermittent confusion and forgetfulness, decline in activities of daily living, and 20-pound weight loss. He lost his job as a delivery man, stopped playing piano professionally, and had difficulty recognizing family members. His primary physician found normal thyroid studies, B12, folate, RPR, HIV, ANA, and C3/4. MRI showed bilateral FLAIR hyperintensities in the temporal …
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