2026 SOAP Annual Meeting

Background

•Parturients with neurologic disease and impaired capacity present challenges.

•Patients with neurosyphilis present issues with the use of neuraxial anesthesia:

•neurologic deterioration

•further dissemination of the disease

•difficulty identifying new neurologic deficits.

•We present a case in which mentation and cooperation also pose a challenge.

Case Description

•A 33-y/o G2P1001 @ 35 w, limited prenatal care admitted for delivery planning.

•PMH: Right temporal lobe tumor resection, refractory epilepsy, A&O x 0-2.

Borderline intellectual d/a, major depressive and anxiety d/o w/ suicidality

Late latent syphilis and active neurosyphilis. Recent neuro-ICU admission for status epilepticus necessitating intubation (likely due to missed medication). Jehovah’s witness with refusal of allogeneic blood products.

•Multidisciplinary plan (MFM, neurology, ID, ethics, bloodless medicine, anesthesia) Cesarean delivery was planned @ 36 + 6 weeks. Preoperative antiepileptics, anxiolysis, followed by RSI f/b maintenance volatile -> TIVA.

•Uncomplicated CD, Apgar scores 8 and 8. Long-acting IV opioid intraoperatively f/b bilateral TAP blocks for postoperative analgesia.

Discussion

•Neurosyphilis is not an absolute contraindication, but a safe awake neuraxial anesthetic requires patient cooperation.

•Active CNS infection raises theoretical risks of pathogen spread, exacerbation of neurologic injury, and difficulty attributing postoperative changes to anesthetic versus disease progression.

•Some literature supports NA in treated or asymptomatic neurosyphilis, but limited guidance in active disease and impaired capacity.

•Multidisciplinary coordination and ethical consultation are critical in optimizing outcomes for medically and socially complex parturients.

2026 SOAP Annual Meeting

Cesarean Delivery in a Parturient with Refractory Epilepsy and Neurosyphilis

Poster Presenter

Authors

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