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Syphilis (cerebral)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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General paralysis of the insane is a syndrome of madness and weakness occurring in tertiary syphilis, which is now very rare because of treatment with penicillin.

The signs of this condition are usually those of:

  • sudden personality change
  • radical alteration of the patient's previous ethical and moral standards
  • development of extravagant and grandiose behaviour
  • the clinical picture then seems to level out and then is followed by a progressive dementing illness
  • there may be an accompanying affective state of flat euphoria
  • the patient may have Argyll-Robertson pupils


  • CSF pressure is often slightly raised
  • microscopy shows an excess of mononuclear cells and protein with a marked increase in globulin fraction
  • serology is always positive

Death usually occurs within three years.

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