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
2. What is the nature of the typical seizures of general paresis?
The most frequent seizures are epileptiform and bear a general
resemblance to cortical epilepsy; but more rarely these seizures
resemble the ordinary epileptic attack or consist of a violent
general shaking of the whole body. A variety of initial minor
disorders usher in the attacks: the temperature is often
increased. The attacks are over after one or at most after a few
hours. Kraepelin speaks of one that lasted 14 days. Sometimes a
_status paralyticus_ develops, suggestive of the _status
epilepticus_. Another rarer form of characteristic seizure is the
apoplectiform, which can hardly be told from an ordinary stroke,
and may be followed by the usual post-apoplectic phenomena. A good
many of the strokes leading to sudden death in middle life are
probably cases of neurosyphilis although often set down as early
arteriosclerosis of a non-syphilitic nature. Besides the
epileptiform and apoplectiform seizures, there are certain
seizures of a less definite and complete nature, ranging from
simple fainting spells, dizzy spells and petit mal attacks, to
various special forms of irritative muscular contractions and
temporary speech disorders. Sometimes these attacks occur with
complete preservation of consciousness. Transient paresthesias,
visual field defects, and especially attacks of vomiting, which,
according to Kraepelin, may precede paresis by years (of course in
this connection gastric crises of tabes must be thought of), may
be counted as sensory seizures.
3. What is the proportion of paretic cases developing seizures?
Figures vary from 30 to 90%. According to Kraepelin, seizures
occurred in 30 to 40% of his cases at Heidelberg; he was of the
impression that treatment in bed had reduced the number of
seizures. 65% of paretics admitted to Munich (under very free
conditions of admission) were determined to have shown seizures
before their admission to the hospital. Seizures are said to be
somewhat more frequent in men than in women. These paretic
seizures are not due to either hemorrhages or vascular plugging—at
least in the vast majority of cases—and must be ascribed to the
effects of microscopic injuries.
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