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
We made a diagnosis of CEREBROSPINAL SYPHILIS rather than general
paresis on account of, first, the slow course of the disease; second,
the vascular type of the cerebral insult, hardly typical of paresis; and
third, the mild spinal fluid reaction. Treatment will hardly cure the
hemiplegia, at least so far as restoration of cerebral tissues lost in
the insult is concerned. We were perhaps entitled to consider that, as
in the cases of Petrofski (17), O’Neil (19), Robinson (45), the
meningitic process could be arrested. Unfortunately, our treatment of 20
injections of salvarsan over a period of 10 weeks, followed by a number
of months of bi-weekly injections of mercury salicylate, proved
incapable of making any change in the mental and physical picture or in
the laboratory findings.
1. Can we explain the apparently poor reaction to treatment of the
cerebrospinal syphilis in the case of Jackson by supposing a more
deep-seated involvement than the meningovascular involvement
indicated by the hemiplegia and the signs in the fluid? Autopsied
cases in our experience show focal parenchymatous involvements
that have not caused obvious clinical symptoms at any time during
the course of the disease. These symptomatically silent lesions
may have been present.
2. What is the comparative prognostic value of seizures in paretic
neurosyphilis and in such a meningovascular case as that of
Jackson? Paretic seizures are often and indeed characteristically
recovered from. Moreover, autopsies in paretic neurosyphilis
characteristically show no gross focal destructive lesions to
correspond with the seizures. The paretic seizures are apparently
more irritative than paralytic. However, the seizures of the
meningovascular group of neurosyphilis are also, though less
commonly, recovered from, so that the differential diagnosis on
the basis of the outcome of seizures is not safe. Rarely paretic
neurosyphilis itself also develops seizures from which no recovery
is made.
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