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
The sutures in the =calvarium= are well outlined; diploë large in
amount. The =dura= is diffusely but lightly adherent to the
calvarium; it is very dense, especially over the left hemisphere.
The meningeal arteries are thickened but not atheromatous. The
sinuses contain a small amount of fluid blood and post mortem clot.
The inner surface shows nothing abnormal. There is a great
flattening of the convolutions of the left hemisphere, which is not
the case on the right side. Over the convexity, the =pia= is thin
and not abnormal except for some slight adhesions between the
frontal lobes and the two lips of the Sylvian fissures. The pia at
the base over the cisterna, pons, and medulla is thick, cloudy, and
of a grayish gelatinous appearance. It is so thick that it is easily
removable in a large piece.
The surface of the left hemisphere is dry, and the whole brain is
flabby and bulges as if from internal pressure. A section through
the hemispheres at the region of the optic chiasm shows a hard, firm
area in the left hemisphere deep down in the white substance. It is
about 2½ cm. in diameter, with a wavy border. The central part is of
a silver-gray gelatinous-like appearance, with red spots and whitish
streaks radiating from the centre. In the pons on the right side, in
a plane passing through the posterior corpora quadrigemina, are two
pinhead size softenings among the pyramidal fibres. The ependyma of
the fourth ventricle is granular.
=Microscopic examination of the tumor=: The area evidently contains
several central necrotic foci surrounded by zones of infiltration
and proliferation, with bordering areas of nervous tissue showing
secondary reactions. The necrotic area stains poorly. From the edge
there are projections of reddish homogeneous bands, some intermixed
with well-differentiated fibrillæ, probably glia fibrils. The
bordering zone is densely infiltrated with lymphoid, plasma, and a
few epithelial cells. The nerve tissue outside of this zone is
spongy and infiltrated with lymphoid and plasma cells. There are a
few scattered, shrunken nerve cells. In this zone and in the zone of
infiltration near the necrotic area, there are scattered cells
resembling giant cells. There are many obliterated vessels in the
area, and other vessels show many infiltrating lymphoid and plasma
cells in the walls. The examination of the specimen stained by the
methods for bacilli of tuberculosis are negative. The growth is a
classical gumma.
=GUMMATOUS NEUROSYPHILIS (gumma of spinal meninges, “meningitis
hypertrophica cervicalis of Charcot?”). Autopsy.=
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