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 frequently attitudinized and would remain in an apparently
catatonic condition for many minutes. For the most part, she was
resistive and mute and non-coöperative as to examination. From time to
time, she made impulsive suicidal attempts. So far as a somewhat
inadequate =physical examination= was concerned, nothing abnormal could
be made out; in particular, the pupils reacted normally to light and
were otherwise normal. The routine W. R. of the blood serum, however,
returned positive, and in accordance with the policy of the Psychopathic
Hospital, the patient was subjected to a lumbar puncture. The lumbar
puncture yielded a positive W. R., 109 cells per cmm., a positive
globulin and a considerable excess of albumin, and an exceedingly mild
gold reaction—syphilitic type.
Ten days after admission, the patient had a convulsion. She never
regained consciousness, continued to have convulsions for a few hours,
and died, apparently from paralysis of respiration. The heart continued
to beat for a short period after respiration ceased. The =autopsy= was
consistent with the diagnosis which had been rendered after the
surprising results of the W. R. in the blood and the laboratory findings
in the spinal fluid had been learned. There was a generalized
encephalitis with congestion of all the smaller cerebral vessels and
petechial areas in the meninges and upon the cortical surfaces. We
regard the case as one of syphilitic encephalitis.
The brain weighed 1265 grams, indicating a loss of 79 grams by Tigges’
formula (8 times the body length in centimetres). The pia mater was, in
the gross, quite normal within the cranium; nor were any cells found in
a smear from this pia mater; but the pia mater over the spinal cord was
visibly edematous, and a smear from the spinal pia mater showed great
numbers of lymphocytes and especially of plasma cells—a finding which
was confirmed in stained section, by which a remarkable display of
plasma cells was found plastered somewhat generally over the entire pia
mater of certain segments. The brain substance was softer than normal,
but displayed no differences of consistence. The stripping of the pia
mater of the temporal lobes on both sides yielded the so-called
“decortication” (that is, the adhesion of small bits of brain substance
to the pia mater). The optic nerves were somewhat thinner than normal.
No other gross lesions of the brain were found.
The dura mater, although dense and injected, was not otherwise abnormal.
There was an early visible sclerosis of the middle meningeal arteries,
more marked on the left side.
The cause of death, so far as the autopsy revealed it, was bronchial
pneumonia. There was a diffuse nephritis.
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