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
Wassermann reaction serum positive. Examination of spinal fluid: clear,
globulin ++++, albumin ++++; cells, 130 per cmm.; small lymphocytes,
79.9%; large lymphocytes, 14.1%; polymorphonuclear leucocytes, 4.6%;
plasma cells, 0.7%; endothelial cell, 0.7%. W. R. positive. Gold sol
reaction, 55555522 +-.
=Mental Examination.= On admission patient showed great psychomotor
activity, was very playful, marked flight of ideas, was expansive, very
emotional, very erotic. She slept very little, appetite was poor, and
she lost weight rapidly. Orientation and memory intact. No
hallucinations elicited. In about three weeks improvement began, and at
the end of eight weeks she appeared practically recovered. On April 9,
1915,—that is, 13 weeks after admission,—she was allowed home on visit.
On leaving, she appeared normal in every way. There was no evidence of
psychotic symptoms, she had good insight, and physically there was
absolutely nothing of a neurological nature that was abnormal.
This case, with the history of a previous depression and its clinical
picture during the acute stage, and its recovery, is certainly in every
respect typical of manic-depressive insanity, and only the positive
result of the six tests causes us to put it in the group of GENERAL
PARESIS. Only the further course will shed any light as to the correct
significance of these findings, and even then we shall not be too sure
that we had not been dealing with a manic-depressive psychosis in a
latent neurosyphilitic. We would strongly emphasize the point that at
the present time this patient presents no mental or physical signs of
cerebrospinal syphilis or general paresis; but the six tests are still
positive. This case differs from the ordinary general paresis remission
in that there is not a single physical sign of paresis present.
There are many transitional cases between this case which shows no
symptoms or signs of neurosyphilis except the laboratory tests, and the
typical case of general paresis. Thus we have cases with slight
character change and no physical signs except rare “seizures.” On the
other hand, in many cases the presence of abnormal neurological
phenomena without definite mental signs is first noted. Certain remitted
cases show only some slight pupillary or reflex abnormality. We believe
we have here added the last link in the chain between the primary and
quaternary symptoms.
This case is illustrative of several which we have published elsewhere
under the name of _paresis sine paresi_ or latent neurosyphilis to
illustrate how all the laboratory signs of neurosyphilis may be present
in a patient without any physical or mental symptoms that may be
correlated with these findings.
We summarize our discussion of this as follows:
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account