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
We do not care here to insist that the right pupil was really an example
of the Argyll-Robertson phenomenon since the slightest tinge of doubt is
important if a positive diagnosis is practically equivalent to asserting
syphilis. Practically, however, the right pupil was regarded as an
Argyll-Robertson pupil under hospital conditions (flash-light reaction).
Argyll-Robertson pupil, areflexia, speech disorder, writing disorder,
memory disorder, conduct disorder, and euphoria, all with a history of
convulsions, certainly warranted the tentative diagnosis of
neurosyphilis.
As usual, resort was made to the W. R. in the serum and in the spinal
fluid. One of the first results to come through from the laboratory was
the absence of globulin, normal albumin, negative gold sol reaction, and
a cell count of two cells per cmm. in the spinal fluid. Later the _W.
R.’s_ were returned _negative_ for blood and spinal fluid.
In the meantime, an illuminating change had occurred in the patient, for
two days later,—three days after the first convulsion in the park,—the
patient had apparently quite recovered; his consciousness became nearly
clear; he could remember every event up to the time of the convulsion,
and his memory came back in appropriate degree for both remote and
recent events.
The patient, it appeared, had for some time been drinking more and more
heavily. In recent days, he had been taking five or six whiskeys and a
half dozen beers daily on the average, and often much more. About ten
years before, the patient narrated, there had been a convulsion at a
ballgame, and this convulsion the patient himself called a “rum fit.”
Here, then, is a case of ALCOHOLIC PSEUDOPARESIS. Without the W. serum
test and without the spinal fluid examination, it is probable that the
diagnosis of general paresis might have clung to the patient for some
time on account of the apparent Argyll-Robertson pupil, which had to be
accepted as such on the flash-light data. In point of fact, in this case
the pupil later reacted more normally to light, and the speech and
writing disorders measurably cleared up.
1. Can alcohol produce the Argyll-Robertson pupil? The majority of
neurologists would today answer, Yes.
2. If in the case of Francis Murphy, the W. R. in the blood had
happened to be positive on account of a non-neural syphilitic
infection (spinal fluid negative), would the diagnosis _general
paresis_ be warranted? Probably the diagnosis _general paresis_
would have been made. If the patient had been lost to observation,
he might well have been regarded as an atypical paretic with
prodromal convulsions.
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