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 may set the total duration of symptoms in the case of James McDevitt
at a little over a year; nor is there any evidence of previous or
prodromal symptoms beyond a total period of about 15 months, unless we
may regard his leaving the General Electric Works to become a bartender
some nine years before death, as a symptomatic change of character. In
any event, it is of note that the =autopsy= showed singularly few
lesions. Death was due doubtless to complications following decubitus,
and there was a slight acute splenitis. The kidneys showed some
parenchymal change. The aorta showed many patches of sclerosis, with
calcification or ulceration throughout its length. These changes were
not characteristic of syphilitic disease. There was considerable
coronary arteriosclerosis and a slight mitral valvular sclerosis. There
was a brown atrophy of the heart muscle, somewhat surprising in a man of
34 years. The =brain= was practically normal, weighed 1200 grams, and
showed convolutions normal in size, relation, and arrangement. There was
no sclerosis grossly evident in the blood vessels. The pia mater
appeared to contain a considerable excess of clear fluid. The calvarium
was of normal thickness and showed diploë and the dura mater failed to
show adhesions. There were no macroscopic signs of lesion in the spinal
cord.
=Microscopically=, the lymphocytosis, plasmocytosis, and phagocytosis of
the perivascular spaces, (relative?) increase in blood vessels, the
gliosis, and evidence of nerve cell destruction, taken together
warranted the diagnosis of PARETIC NEUROSYPHILIS. It was plain that the
nerve cell destruction was best marked in the _inner layers of the
cortex_. The microscopic study of the spinal cord showed that there was
very possibly a slight sclerosis of the posterior columns in the lumbar
region, but this was so slight that it could hardly be noted in the
myelin sheath stains (Weigert). Very sharply marked, on the other hand,
were the _bilateral pyramidal tract lesions_ in the lumbar and thoracic
regions, less marked at the cervical levels.
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