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
The patient’s speech showed considerable defect. Words were pronounced
slowly with slurring and tripping especially of the labials. Orientation
perfect. School knowledge well retained. The easier arithmetical
problems were accurately performed. Memory imperfect for minor recent
events. Estimations of space and time often very imperfect. Variability
of mood, sometimes euphoric, sometimes tearful and irritable. Occasional
expansive estimates of personal powers (“Can lift three five-hundred
pound weights with one finger”). Indistinct expansive financial ideas.
The patient continued oriented, euphoric, expansive, untidy, till
October, 1905, but on October 12 developed an infection at the site of a
callus on the sole of the foot and died with pyemic symptoms, October
17.
=Post Mortem Findings.= The =cause of death= was streptococcus
septicemia with acute ulcerative colitis, acute splenitis, bilateral
purulent pleuritis, multiple infarctions of lungs.
There were no signs of =chronic disease outside the nervous system=
except a moderate thickening of the mitral valves, and slight dural
adhesions.
The brain weighed 1450 grams. The vessels at the base showed a slight
degree of sclerosis. There was a slight opacity of the frontal,
parietal, and temporal pia overlying slightly atrophied convolutions,
whose surfaces showed in a few places slight cuppings. The ependyma over
the thalami and the floor of the fourth ventricle was finely roughened.
The spinal cord showed a typical TABES DORSALIS.
Although we probably cannot regard either Case 42 or Case 43 as a case
of paretic neurosyphilis, and although it must remain doubtful whether
they are cases of any form whatever of neurosyphilis (in the absence of
the modern tests), yet it seems clear that both these cases may very
well have been cases of neurosyphilis on account of the existence of a
definite tabetic process in each. The symptoms of these cases, like
those of Cases 38 to 41, suggest how difficult it must be _to make a
clinical diagnosis of general paresis safely without employing available
laboratory tests_. Yet how frequently in the past have neurologists
brought data concerning various phenomena in long series of so-called
paretics in which the error of diagnosis was certainly between 5 and 15%
and frequently still greater. The entire question of the symptomatology
of paretic and non-paretic neurosyphilis, therefore, needs re-opening
and revision.
=CEREBRAL GLIOSIS (probably non-syphilitic) producing the clinical
picture of paretic neurosyphilis (“general paresis”). Autopsy.=
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