Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories — John Shaqi
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
=Cranial nerves:= Refuses to respond to any tests to determine
hearing or vision, but evidently hears what is said to him, and in
his movements gives no evidence of deafness. Right corner of mouth
droops; tongue protrudes straight.
=Reflexes:= Pupils dilated; margins irregular; left pupil larger;
they vary in size but it is impossible to determine whether the
variation is due to light or accommodation reflex. Reflexes of right
side extremely exaggerated throughout; there is little ankle clonus;
Babinski is not obtained, patient holding his toes in flexed
position in resisting attempts to elicit reflexes.
=Sensations:= Reaction to pain stimuli on either side. Evidently
some anesthesia on right side, but pressure is apparently very
painful. There is considerable spasticity of limbs on right side on
passive motion. Too demented to make accurate tests.
The above examination was made on May 6, 1904. On May 20th the
record states:
There is almost complete sensory aphasia with word-deafness; some
paraphasic circumlocution. Many of his words are very well
enunciated but have no meaning. Is apparently unable to recognize
objects or their uses.
Brother stated that he was always supposed not to be over bright.
Physician’s certificate states that he is epileptic, averaging two
attacks per week. On the 15th of May he had a general convulsion;
was unconscious for half an hour, and dull and drowsy for two hours
afterwards. On the 19th, he had a similar attack in the afternoon,
the convulsion lasting a minute, and he was stuporous for an hour.
On November 8th he had a severe epileptic convulsion. His body was
curled up to the right. The convulsive seizure lasted for two
minutes and was followed by complete unconsciousness for an hour,
when the patient roused and appeared as usual in a few minutes. From
that time to December 15th he had five epileptic convulsions; he was
much more feeble, and unable to help himself as much as formerly.
Nov. 7, 1905: Patient has had occasional convulsions since last
note, but none during the last three months. He is confined to bed,
has become very much demented, and shows very marked speech defect,
so that he is almost unintelligible. He understands only the
simplest directions. Legs are considerably contracted and knees are
flexed. Arm and hand on the right are paralyzed and show some
atrophic changes; partially flexed. Left elbow jerk is very lively.
On May 23, 1906 he was reported as having Achilles on right side
only, and Babinski on right side. He died January 5, 1907.
=The autopsy findings= were as follows:
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