Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case historiesSouthard, Elmer Ernest
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Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories
Southard, Elmer Ernest
Neurosyphilis
Head:—Bald on top. Hair =gray=. Scalp normal. Calvarium thin, deeply
excavated by arachnoidal villi to right of vertex. Diploë absent.
Dura closely adherent in bregmatic region. Dura of usual thickness.
Sinuses contain cruor clot. Arachnoidal villi slight. Pia mater hazy
and over sulcal veins porcelain white over all of vertex except
occipital poles and over flanks (notably left). Thickened also
around circle of Willis, over culmen monticuli and in posterior
cerebellar notch. Edema of pia corresponding to atrophy of frontal
and central regions. Cerebral atrophy most marked in orbital
surfaces of both frontal lobes, in left area of Broca, and in left
supramarginal region. The ascending branch and the ascending ramus
of the posterior limb of the left Sylvian fossæ both readily admit
the thumb by reason of atrophy of adjacent substance. Induration
corresponds closely with atrophy, but is not more marked about the
left Sylvian fossa. There is sclerosis of both hippocampal gyri,
with loss of the substantia reticularis alba. The culmen monticuli
and lobus culminis are firmer than the clival regions, and the lobus
cacuminis is again slightly firmer than the clival region.
Cerebellum a little softer than usual. Pia strips with usual
readiness from all regions. The subpial region of the frontal lobes
is a trifle grayer than that of the rest of cerebrum. Ventricles
slightly dilated. Surfaces evenly sanded. Floor of fourth ventricle
shows numerous coarse, closely set granules. Brain wt. 1200 grms.
Cord shows a slight increase of consistence over one or two upper
thoracic segments and in lumbar enlargement corresponding with a
slight graying out of posterior columns. In places there is a
suggestion of graying out also in lateral columns. A few calcified
plaques in posterior lumbar pia.
Analysis of these details shows a number of lesions that characterize
paretic neurosyphilis (among others, granular ependymitis, frontal
atrophy, chronic leptomeningitis), but the lesions are more than merely
frontal, extending as they do back as far as the postcentral regions on
both sides, and even as far as the left supramarginal gyrus. The
cerebellar involvement although frequent, can hardly be said to be
characteristic in paretic neurosyphilis. The spinal involvement is
characteristic of a case which is probably to be regarded as one of
taboparesis; that is, of paretic neurosyphilis following a number of
years after the establishment of tabetic neurosyphilis. The aorta is
almost constantly affected by sclerosis in paretic neurosyphilis. The
absence of diploë in the skull is not infrequent and the adherent dura
mater is often found.
Microscopically, the tissues showed the characteristic lesions of
PARETIC NEUROSYPHILIS; nerve cell destruction, fibrillar and cellular
gliosis, lymphocytic and plasma cell deposits about the small vessels.
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