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
1. Are the hallucinations in the case of O’Brien characteristic?
Hallucinations are regarded as playing a minor rôle in general
paresis. In fact, earlier workers sometimes denied that
hallucinations occurred at all, and this denial has been made once
more of late by Plaut,[15] but Kraepelin quotes Obersteiner as
observing hallucinations in 10%, and regards that figure as
approximately corresponding with his own experience. Junius and
Arndt are cited as finding 17% of their cases hallucinated.
Auditory hallucinations are somewhat more frequent than those of
vision (alcoholic psychosis must be considered). The visual
hallucinations of paresis are thought by Kraepelin to be related
with atrophy of the optic nerves, and he states that they occur by
preference in patients having such atrophy. Hallucinations though
not common are more frequent in non-paretic neurosyphilis than in
paretic neurosyphilis.
2. What was the cause of death in Margaret O’Brien? The autopsy, as
above stated, indicated pneumonia. In point of fact, this patient
developed convulsions and ceased respiration, the heart continuing
to beat for some time after respiration had ceased. It may be that
the death should be counted as one of neurosyphilitic seizure.
=Tonsillar abscess associated with neurosyphilis (Lues Maligna?).=
=Case 69.= Frank Mason, 49 years, a rectifier of spirits, was admitted
to the Psychopathic Hospital in a tremulous, mentally confused,
depressed, and unhappy state. He was particularly concerned because he
could not give an accurate account of his past life and because he found
that he was continually contradicting himself.
Superficial examination shortly discovered the pupils to be much
contracted, irregular, and non-reactive either to light or distance.
Although these pupils showed more than the Argyll-Robertson phenomenon,
yet the suspicion of syphilis was important.
Throat examination showed a large area of ulceration involving the whole
of the right tonsil and extending even to the left side of the median
line so that the whole of the faucial pillar was involved. In the midst
of this ulcerative area was a mass of purulent necrotic tissue, about
which the edges of the ulcer stood out sharply. There was, however, very
little acute reaction about the margin of the area.
The association of pupillary changes (especially stiffness to light),
what looked like tonsillar gumma, and mental disorder (including memory
disturbance) heightened the impression of syphilis.
However, the remainder of the examination was not especially
confirmatory of the diagnosis. The man was well developed and obese,
with a slightly enlarged heart, with sounds of poor quality and the
aortic second sound accentuated. The systolic blood pressure was 130;
the diastolic, 90. There was no disorder of reflexes except that the arm
reflexes were very lively.
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