Aform of cerebral syphilis in which the blood vessels and brain coverings (meninges) are attacked by the spirochete germ. The damage is usually diffuse rather than localized, and the symptoms are quite different from those in meningo-encephalitic syphilis (general paresis), in which the neural tissue itself is destroyed. In many cases, however, there is a mixture of types.Meningovascular syphilis is relatively rare and constitutes less than 1 per cent of first admissions to mental hospitals. It takes two major forms: syphilitic meningitis and vascular neurosyphilis.Syphilitic meningitis may involve either impairment in absorption of the cerebrospinal fluid (“acute syphilitic hydrocephalus”), inflammation of the base of the brain (“basilar meningitis”), or inflammation of the meninges around the upper part of the brain (“vertical meningitis”). The hydrocephalic type, which is rare, is characterized by headache, nausea, vomiting, and stiff neck. In the basilar type the major symptoms are headache, dulled mentality, impairment of’ memory for recent events, sleepiness, and in some cases confusion, delirium, and stupor. The cranial nerves may be affected, resulting in such symptoms as double vision, facial anesthesia, and deafness. The vertical type involves more extensive areas of the brain and produces a wide range of symptoms.These include severe headaches, dizziness, irritability, loss of concentration, retarded thought and speech functions, and sometimes confusion and delirium. In contrast to general paresis, syphilitic meningitis does not lead to serious impairment of the personality, delusions, or serious disturbance of behavior, judgment, and social reactions.Vascular neurosyphilis usually accompanies the early stages of syphilitic meningitis. Early symptoms are intermittent headaches, often worse at night, dizziness, insomnia, irritability, emotional instability, increasing apathy, and impairment of memory. Vascular (circulatory) accidents frequently occur, causing temporary neurological disturbances, such as aphasia and hemiplegia (paralysis of one side of the body), and resulting in some loss of intellectual capacity.The treatment of choice for all types of meningovascular syphilis is penicillin, and excellent results are achieved unless permanent damage to neural tissue has already taken place. For other details on diagnosis, treatment, and prevention, see syphilis.