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
According to the patient’s own history, he had had several attacks of
gonorrhœa and a syphilitic infection at the age of 19; that is, some 31
years before admission to the hospital. However, the first
_neurological_ symptoms of which the patient was aware came about 27 or
28 years after infection, namely, 3 or 4 years before admission, when
facial paralysis developed. At that time, he had suddenly felt a
peculiar sensation in the throat and became unable to swallow for a
time. His voice remained hoarse and low for some time, and his face
began to droop. The lancinating pains and the ataxia also dated back
several years.
1. How shall we evaluate the mental symptoms? The prognosis of tabes
dorsalis is relatively good so far as life is concerned, and it
might even be possible for Sullivan by training to remain capable
of being a waiter. The manual incoördination was not marked, and
possibly the manual tremor was in part due to alcohol.
Accordingly, the mental symptoms, such as emotional lability and
memory defect, were in the foreground of attention. In point of
fact, the laboratory examinations showed positive W. R. in the
serum and the spinal fluid, which latter also contained 60 cells
per cmm., positive globulin, and an excess of albumin. THE
DIAGNOSIS MADE WAS THAT OF TABOPARESIS, meaning thereby a tabes
associated with appropriate symptoms of a mental nature.
2. How shall the term _taboparesis_ be used? Some use the term, as
we feel erroneously, for instances of general paresis which happen
to show crural areflexia (absence of knee-jerks). We feel that the
best usage of the term is for instances in which well-defined
symptoms of tabes (as well as of paresis) are present, namely,
characteristic ataxia, lightning pains, and the like. If the term
is used more loosely, as above mentioned, then practically every
case of general paresis might perhaps be termed _taboparesis_,
since almost every case of paresis does show involvement of the
cord as well as of the cerebrum. Such involvement may lead to
hyperreflexia, hyporeflexia, or areflexia according to the
localization of the process. In true taboparesis, in which there
is a commingling of the features of tabes with those of paresis,
we should find the posterior roots of the spinal cord affected.
The spinal lesions of paresis itself are more apt to be
intraspinal; that is, confined to the nervous system within the
pial investment.
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