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
Upon investigation, it appeared, however, that a year before the attack
above described, the patient had been examined and both blood and spinal
fluid found positive to the W. R. At that time, treatment, consisting of
intravenous injections of salvarsan and intraspinous injections of
salvarsanized serum (Swift-Ellis), had been instituted. Whereupon the
laboratory tests had become negative, as above stated, and there had
been no alleviation of the symptoms.
1. How can Rokicki’s normal deep leg reflexes be explained? The
abolition of the deep reflexes is of course due to lesions
properly localized. It is probable that this particular case of
tabes dorsalis is more truly “dorsal” than most cases; for most
cases exhibit lesions involving regions lower than the dorsal.
Both in these dorsal cases and in certain rare cases of cervical
tabes, the deep leg reflexes are preserved. (See cases Green (30)
and Halleck (31).)
2. What is the mechanism by which a characteristic gastric crisis is
produced? The mechanism is unknown. Some endeavors have been made
to meet gastric crises by surgery of the posterior roots, on the
assumption that the irritation causing the pain was located either
in the posterior ganglion or in the passage of the nerve through
the meninges. In only a few instances, however, has the result
been what was desired. In many instances the gastric crises and
pain continued uninterrupted and in addition came discomfort due
to the lack of sensation in the part supplied by the severed
nerve. At present this treatment is seldom carried out.
3. Should antisyphilitic treatment be continued in such a case? As
far as our present knowledge of syphilis goes one would hesitate
to suggest further antisyphilitic treatment, feeling that the
active process had been entirely stopped as suggested by the
absence of any positive findings either in the blood serum or in
the spinal fluid. We should perhaps conclude that there was no
more activity in this case and that the crises were due to the
changes that had already taken place in the nerve tissue and which
could no longer be changed.
=The literature is in doubt concerning (in fact is preponderantly
against) the success of treatment in PARETIC NEUROSYPHILIS (“general
paresis”). Our experience has yielded a number of apparently
successful results through systematic intensive intravenous
salvarsan therapy. Example.=
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