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
2. Is the case of Forest to be regarded as one of general paresis?
Sometimes such cases are termed in the literature _syphilitic
pseudoparesis_ (see case Burkhardt (58)). The differential
diagnosis of this group is entirely therapeutic. There are,
unhappily, no laboratory tests which will suffice in the present
stage of knowledge to differentiate a case of so-called
pseudoparesis from general paresis. We are inclined to term the
case one of GENERAL PARESIS, with recovery, or, at all events,
with remission.
=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.=
=Case 113.= We present the case of Gussie Silverman, a housewife, 35
years of age, among other reasons, for its social interest. The case is,
on the whole, sufficiently typical of GENERAL PARESIS. =Physically=, for
example, the pupils failed to react to light and accommodation and were
unequal, the right being larger than the left. The knee-jerks were
sluggish though equal. The ankle-jerks could not be obtained. The
abdominal reflexes were not obtained. Otherwise, there was no reflex
disorder.
From the =laboratory= point of view, the W. R. was positive in the blood
and in the spinal fluid. There were 80 cells per cmm. and there were an
appropriate globulin and albumin reactions. Mrs. Silverman was rather
poorly nourished and had a slight edema of the ankles.
=Mentally=, she was found on admission to be markedly depressed. It
appeared that during a recent pregnancy, terminated by the birth of a
7–months child, she had fainted several times a day, that since the
confinement she had been very nervous, that she had been asking her
husband not to send her away, that she had refused to leave the house,
that she had become excited even to the point of injuring herself,
especially at night, and that she would go so far as to scratch her
husband, shortly afterward being very sorry for her performances. Before
this last pregnancy there had been four others and the resulting
children were all apparently in good health. Except for the fainting
spells during the pregnancy, it would not appear that the story just
told is at all characteristic of paresis.
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