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
=Physically=, the patient was sallow, poorly nourished, with pale mucous
membranes, peripheral arteriosclerosis, no teeth, muscular feebleness,
tremor of hands and tongue, and active knee-jerks. =Mentally=, the
patient was depressed, talked to herself, assumed a supplicating
position, suddenly altered her attitude, and was very tremulous. Her
talk was low, mumbling, and incoherent, for the most part composed of
answers to her own questions. Sometimes there was a curious difficulty
in speaking, such that the lips moved but no sound emerged; but for the
most part there was no difficulty in uttering words. The patient either
could or would not write. Only when the attention was secured by
speaking to her sharply was she apparently able to understand questions,
and the answers to these sharp questions came spasmodically and as if
interrupting her own thoughts. Nor was it ever possible to obtain a
repetition of the same answer.
The patient died in exhaustion, with pulmonary symptoms three weeks
after admission.
The =autopsy= which was performed 3½ hours after death showed the
following points of interest:
The heart weighed 210 grams. There was marked thickening of the aortic
valve. The coronaries were slightly thickened.
The lungs were slightly adherent to the chest wall at the apices and
posteriorly. The right lung was consolidated in the lower two lobes
posteriorly and the bronchi exuded pus; the left lung was not
remarkable. There was a chronic splenitis.
The liver showed fibrous changes, was a brownish-red in color, mottled
with yellow.
Combined weight of the kidneys 195 grams. The capsules were adherent,
tearing the cortex when stripped.
The diploë were well marked. The dura was not adherent. The pia was
slightly thickened and raised from the cortex by a large amount of
subpial fluid (showing atrophy of the cortex). The pial vessels were
injected, more markedly so on the left side. The arachnoid villi were
reported as moderately developed, especially along the longitudinal
fissure.
The brain was rather soft in all regions. The weight was 1045 grams.
According to Tigges’ formula the weight of the brain should be
approximately 8 times the body length in centimeters. The length in this
case was 158 cm., therefore, according to this formula the weight of the
brain should have been 1464 grams. The difference of more than 400 grams
is evidently a loss to be accounted for by atrophy, a very heavy loss.
[Illustration:
Perivascular exudate (low power) in atrophic cortex from case of
general paresis.
]
[Illustration:
Markedly atrophic cortex, but without local perivascular exudate.
]
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