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
3. How can the mental symptoms (depression and failing memory) of
which patient complained be explained? In the first place, as has
been stated, it is doubtful if these are more than subjective and
the result of the patient’s feeling of discomfort and pain.
However, it is also possible that there may be intracranial
involvement of the meninges or of the brain itself. And, if such
were the case, the improvement might be the result of the
treatment.
=The Argyll-Robertson pupil should not be used as a basis for a
necessarily bad prognosis if treatment can be given.=
=Case 106.= Frederick Stone was a business man of large interests. He
had been in the hands of physicians for several years for a variety of
disorders such as renal, respiratory, cardiovascular, and so on. No
suspicion of syphilis had apparently been uttered by the physicians
despite the fact that Mr. Stone readily stated that he had had a chancre
thirty years before, and that he had received several years’ treatment
of mercury and potassium iodid by mouth.
It appeared that a few years ago he had begun to have trouble with his
nose, which was cauterized and operatively interfered with without
satisfactory results. This nasal condition had later been diagnosticated
as gummatous, and had improved considerably under a mild antisyphilitic
treatment. However, this nasal condition had been considered and treated
quite separately from the remainder of Mr. Stone’s troubles.
What brought him to attention was a sudden diplopia with ptosis. There
was a paralysis of the external rectus of the left eye, as well as a
drooping of the lid on this side. The left eye was much inflamed. The
diplopia greatly bothered the patient, and there was also considerable
pain in the left frontal region, confined chiefly to the distribution of
the first division of the trigeminal nerve. According to the patient
this headache was periodic. There was considerable tenderness to
pinprick over the area and a diminution of sensory discrimination of
fine touch. Both the pupils failed to react to light.
The remainder of the neurological symptomatic examination was
surprisingly clear of disorder, nor was there anything in the history
suggestive of tabes. There was ozena as well as evidence of the
operative work upon nares and throat. Possibly the arteries were
slightly hardened; blood pressure was 165 systolic. There was a large
trace of albumin, and there were numerous hyalin casts in the urine.
=PARETIC NEUROSYPHILIS=
=(GENERAL PARESIS)=
Cases systematically treated 50
CLINICAL REMISSIONS 34 68%
C.S.F. ALTERED TO NEGATIVE 4 8%
C.S.F. ALTERED TO WEAKER 16 32%
C.S.F. UNALTERED 14 28%
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