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 most striking feature found at autopsy was a bilateral adrenal
tuberculosis (caseation, giant cells, lymphocytosis, tubercle bacilli).
The thymus gland was persistent (7×5×.5 cm.), whereas the thyroid gland
was smaller than usual. The brain showed macroscopic and microscopic
features entirely consistent with the diagnosis of general paresis,
including lymphocytosis, plasmocytosis, irregular degrees of nerve cell
destruction, and gliosis, with an especially characteristic microscopic
picture in the frontal regions.
It may be of note to consider the degree of change undergone by a brain
in 11 years or more of deterioration, and the following description of
the head findings is therefore included:
=Head=: Hair abundant, dark. Scalp normal. Calvarium, weight 435
gm., transparent in bregmatic region only, elsewhere thick and
dense. The average thickness of the vertical plate of the frontal
bone is 7 mm. The frontal bone shows a moderate thickening and
hardening of the inner table with obliteration of diploë. Dura mater
moderately adherent to the bregmatic region of calvarium.
Arachnoidal villi moderately developed. Sinuses not remarkable. Pia
mater shows a moderate focal thickening with opacity, especially
along sulci. Vessels well injected. =Brain=: Weight, 1200 gm. The
brain shows marked focal variations in sulcation and consistence.
Spread on a board, the right hemisphere is obviously somewhat bigger
than the left. There is a difference of only 0.5 to 0.75 cm. on
measurement of the greatest circumference of the cerebrum, taken
from the median line superiorly to the median line inferiorly, but
the right hemisphere is throughout slightly more convex than the
left. Both postcentral gyri are much narrowed in their superior
portions, and the sulci posterior thereto are deeper than the other
sulci of the hemispheres. The sulci of the orbital surfaces are
asymmetrical and, on the left side, show a tendency to microgyria.
The cerebral hemispheres as a whole show a remarkable tendency to
slight protrusion of the border gyri; especially those of the two
poles, of the free edges along the great fissure, and most
strikingly the gyri at the boundary line between the inferior and
lateral surfaces. This _marginal prominence_ is slight but obvious
and is emphasized by a slightly paler color in some regions. The
cerebrum shows a general induration which is greatest in the frontal
tips and along the inferior borders of the lateral surfaces of the
hemispheres, especially right. The orbital surfaces are firm,
especially anteriorly and externally (prefrontal); the tips of the
temporal lobes are firm, and the superior temporal gyri are firmer
than adjacent gyri. The postcentral gyri are indurated more than the
other gyri of the superior surface. The hippocampal gyri are
likewise firmer than adjacent gyri.
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