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
Although but 44 years of age, Falvey presented the appearance of a much
older man. His heart was somewhat enlarged and there was a degree of
peripheral arteriosclerosis. On the whole, no special attention was
attracted to this case clinically and he was regarded as an example of
arteriosclerotic dementia, like many another among the transfers.
However, we owe to Dr. H. M. Swift the important observation of the
Argyll-Robertson pupils. The case was studied long before the Wassermann
method was available, and is here reported merely to call attention to
the fact that the stiff pupils may have other neural origin than
neurosyphilis.
The autopsy material in the case was worked up by one of the
authors.[11] The autopsy had been performed by Dr. A. M. Barrett, who
found on section through the brain stem at the anterior border of the
pons a mass springing from and continuous with the pineal gland, lying
in the third ventricle and the aqueduct of Sylvius. Upon further study,
this mass was found to begin posteriorly in the pineal body itself, from
which the mass could hardly be told in the gross except by an injected
border.
This mass proved upon microscopic examination to be a psammoma, which
histologically resembled a glioma rather than a sarcoma. Throughout the
mass there was a variable content of fibrillary intercellular substance
having the histological reactions of neuroglia fibrillæ. The
histological details (mitosis, large giant cells with multiple nuclei,
etc.) do not here concern us. We deal with a neoplasm springing from the
pineal gland growing on the posterior half of the third ventricle, the
anterior orifice of the aqueduct of Sylvius, and the space between the
velum interpositum as far back as the posterior corpora quadrigemina.
There is no evidence in the body of old syphilis; although it is
possible that the stiff pupils were neurosyphilitic, it seems probable
that they were related to the pineal tumor. At all events, there are in
the literature evidences that the pineal-quadrigeminal group of tumors
and other lesions may bring about pupillary disturbances. On this
account, we here include the case. The tumor hardly led to an error in
diagnosis since neither neurosyphilis nor brain tumor was at all
expected clinically.
1. Can alcoholism produce identical results? See Case Murphy, (60),
one of alcoholic pseudoparesis.
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