Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case historiesSouthard, Elmer Ernest
Science
Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories
Southard, Elmer Ernest
Neurosyphilis
He then informed us that he had had a chancre about five or six months
before, followed by a secondary skin eruption; that he had received four
injections of salvarsan (the last, a month before admission) and three
injections of mercury. At about the time of the last injection of
salvarsan, he had developed headache with pain and slight stiffness in
the back of his neck; and a fortnight later, he began to have dizzy
spells, followed during the last week by difficulty in hearing. There
was amnesia for everything that happened after his spell of sudden
excitement on the evening before admission, and this amnesia was never
lifted for the four days that followed.
=Physically=, Bennett was very well built and muscular. Nor were there
any evidences of disease outside the nervous system. There was some
slight stiffness of the neck and slight pain on movement of the head,
which probably ought to be attributed to meningitis. The =neurological
examination= showed tendon reflexes all normal, and normal sensations.
There were, in fact, no neurological signs except that both pupils were
dilated; the left was larger than the right. Both pupils reacted to
light but reacted very poorly. They reacted much better to
accommodation.
The W. R. proved to be positive, as might well be expected in a man
whose infection had taken place less than six months before. The
globulin and albumin of the cerebrospinal fluid were in great excess, of
a degree which we clinically express by ++++. The W. R. of the fluid
also was strongly positive down to 0.1 of a cmm. The gold sol reaction
was the “paretic” type, and there were 228 cells per cmm.
1. How early may clinical evidence of neurosyphilis set in after
infection? Craig found one case of “brain syphilis” occurring one
month after infection. Frye claims a case of tabes dorsalis
developing six weeks after infection. Craig states that he has had
three cases of brain syphilis occurring within six months, and six
within a year of infection.
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