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
2. What is the cause of such convulsions as those developed by David
Borofski? Evidence from clear cases of general paresis with
convulsions leads to the hypothesis that such convulsions as those
developed by Borofski are not necessarily based upon frank
destructive lesions such as would be produced by the plugging of
terminal arteries. They may well be produced through the
activities of minor lesions, only demonstrable by microscopic
methods, either through properly disposed cell losses or by the
pressure of exudate, or even by endotoxins or other substances
derived from the bodies of dead or living spirochetes.
3. Aside from the well-known syphilitic epilepsy due to meningitis,
is there a non-meningitic epilepsy (such a disease as Fournier
formerly described under the term parasyphilitic epilepsy)? We
dismiss from discussion the so-called symptomatic epilepsies which
are the result of a gross organic disease of the brain substance
or its membranes, and which do not differ so far as we are aware
from organic epilepsy produced by other gross lesions of an
identical size and structure. These symptomatic epilepsies may be
partial, or even may present the appearance of generalized
epilepsy. We may also leave out of account those epileptic
pictures which are produced in general paresis itself, and which
may be viewed as nothing but partial phenomena of general paresis.
The kind of so-called “parasyphilitic” epilepsy that Fournier
described is a kind of epilepsy that cannot be distinguished from
genuine epilepsy, in which the sole disease-phenomenon throughout
a long period of time consists of epileptic convulsions. It
appears that these “parasyphilitic” imitations of genuine epilepsy
occur in individuals with a very long post-infective “incubation
period,” but that there are some cases in which the epilepsy
appears, on the contrary, in the very earliest stages of syphilis.
The attacks are a little less common than those of idiopathic
epilepsy; they have the same apparently causeless beginning; are
associated with complete amnesia; and are followed by
characteristic dazed states. The patient’s intelligence, however,
suffers little. Now and then a case reacts well to antisyphilitic
treatment energetically pushed. (Spontaneous long remissions in
non-syphilitic epilepsy must be remembered.) Petit mal attacks
occur sometimes between the more severe attacks. In short, it
would appear that there is a group of syphilitic epilepsies in
which the brain shows no gross structural lesions, which
accordingly do not exhibit any Jacksonian appearances, and which
last a comparatively long time without changing their character,
and often without being especially altered for the better by any
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