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
=Microscopic findings= are here presented merely in sufficient
detail to establish the diagnosis. The left superior frontal gyrus
shows extensive and somewhat irregular cellular and fibrillar
gliosis of the plexiform layer, together with an increase of
thickened vessels having lymphocytes and plasma cells in their
sheaths.
The perivascular infiltrations are most extensive in the lower
layers of the cortex. The lamination is in places thoroughly
obscured, except that representatives of the layer of large external
pyramids are almost always demonstrable.
The layer of medium-sized pyramids has undergone more numerical loss
of elements than have the other layers.
Gliosis of white matter.
Specimens from the cerebellum show a destructive process of great
severity, but a little irregular in extent, affecting chiefly the
Purkinje cell belt. The Purkinje cells are often absent throughout
one side of a given lamina, and there has ensued a dense
accumulation of neuroglia cells along a former Purkinje cell belt,
together with a considerable gliosis of the molecular layer.
Considerable gliosis of the white matter, both diffuse and
perivascular in distribution.
Perivascular plasma cell infiltrations as in cerebrum, but largely
meningeal or in the white matter.
Sections from the corpora striata demonstrate a mild and early
granular ependymitis, considerable subependymal gliosis of cellular
type, considerable perivascular gliosis in the white portions of the
tissue, and a moderate infiltration of perivascular sheaths with
pigmented cells, lymphocytes, and plasma cells. There is little
evidence of alteration in the nerve cells. Some are unevenly
pigmented.
=Summary=: We here present a case with numerous and widespread
neurosyphilitic lesions. However, the gross cerebral vascular
complications of Case 1 (Alice Morton) and of Case 2 (Francis Garfield)
are notably absent in James Dixon. Rather atypical (there seems to be
_always something atypical in cases of neurosyphilis!_) are the liver
lesions and arteritis of the leg, atypical, that is to say, for PARETIC
NEUROSYPHILIS. Highly typical of paretic neurosyphilis and almost
constant therein is the aortic sclerosis.
[Illustration:
Apparent new formation of small blood vessel. Photographed by Dr. A.
M. Barrett.
]
[Illustration:
Rod cells (Stäbchenzellen) in paretic neurosyphilis. Photographed by
Dr. A. M. Barrett.
]
[Illustration:
Granular ependymitis—microscopic appearance of a marked example of
“sanding” of ventricle.
]
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