Neurosyphilis

Description:

The term "neurosyphilis" includes the whole range of syndromes of defeat of TsNS which were classified by H. Meritt and coauthors in the monograph "Neyrosifilis" of 1946. On the basis of the analysis of 656 patients with neurosyphilis classification was offered and the specific weight of occurrence of these or those its forms is specified.

  1. Asimptomny neurosyphilis — 31%
  2. Syphilitic meningitis — 6%
  3. Meningovaskulyarny syphilis
          * Cerebral (meningitis, a stroke) — 11%
          * Spinal (a meningomyelitis, a stroke) — 3%
  4. Parenchymatous neurosyphilis
          * A general paralysis — 12%
          * Back tabes — 30%
          * A taboparalysis (a combination of a general paralysis and back tabes) — 3%
          * An atrophy of an optic nerve — 3%
  5. Gummous neurosyphilis — 1%
          * Brain gumma
          * Gumma of a spinal cord

Neyrosifilis's symptoms:

Early neurosyphilis. Clinical displays of early neurosyphilis appear in the first 2 — 3 years after infection and correspond to the secondary period of a disease. Pathomorphologically early neurosyphilis characterizes defeat of vessels and covers of a brain. In a meninx signs of a proliferative inflammation are defined. In vessels there is an intima hyperplasia to education around them miliary gummas. The most frequent display of early neurosyphilis is chronic syphilitic meningitis. A pathognomonic symptom in differential diagnosis with meningitis of other origin is Argaylya-Robertson's symptom — reaction of pupils to accommodation and convergence is kept, and on light is broken. Carry early meningovaskulyarny syphilis to more rare forms of early neurosyphilis, syphilitic neuritis and polyneurites, a syphilitic encephalomeningitis. The clinical picture of early neurosyphilis depends on the struck structures and is in many respects similar to infectious inflammatory diseases of a brain of other etiology.
The fact that all diseases given above a form develop through a considerable period after infection is characteristic, and serological diagnosis rather often cannot reveal existence of a syphilitic infection. Most quicker latent syphilitic meningitis which arises through 2 and over a year after infection develops, other forms of late neurosyphilis need 10 — 15 years for development of clinical displays of a disease. Depending on a form of a disease the clinic of its current differs, however in general the symptomatology is similar. At patients paralyzes, paresis are observed, there are headaches, can will be broken higher nervous activity, ability to logical thinking decreases, memory and attention worsens.
Asimptomny neurosyphilis. The state at which there are no clinical symptoms of defeat of a nervous system and the diagnosis is established on the basis of inflammatory changes in liquor. Inflammatory changes of TsSZh are found within 12 — 18 months from the moment of infection.
Syphilitic meningitis. Allocate three clinical forms of syphilitic meningitis: acute syphilitic hydrocephaly, acute basal syphilitic meningitis and acute konveksitalny syphilitic meningitis. At a basal form a meninx of area of a base of skull preferential is surprised, at konveksitalny — areas of a calvaria.
Meningovaskulyarny syphilis. Clinical symptoms at meningovaskulyarny syphilis are connected both with chronic meningitis, and with disturbance of cerebral circulation owing to a vasculitis of arteries of large and average caliber. The inflammation leads to accession of thrombosis and occlusion of a vessel. For several weeks or months before development of an ischemic stroke in a half of patients the headache, dizziness, changes of the personality and behavior, sleeplessness and convulsive attacks are noted.
Back tabes.
Back the tabes are characterized by defeat of spinal nerves, nervous ганглиев and back columns of a spinal cord. As a result at the patient specific disturbance of gait — a sensitive ataxy forms. In the struck zadny columns of a spinal cord there pass Gaulle and Burdakh bunches who are responsible for deep muscular and joint sensitivity. The patient during walking does not feel a support. It cannot move blindly, the feeling of position of a body in space is lost.
General paralysis.
The general paralysis represents the progressing encephalomeningitis developing gradually with the peak of incidence in 15 — 20 years after infection. Imitates displays of many mental diseases. Begins with irritability, decrease in memory, impossibility to concentrate and changes of the personality. In process of progressing disinhibition, asocial behavior and nonsense join. Before penicillin use patients with a general paralysis made from 5 to 10% of all sick psychiatric hospitals. In end-stages dementia, paralyzes and dysfunctions of pelvic bodies develop. Development of paralyzes, unusual to mental diseases, also led to emergence of the name of a disease of armor. paralysis progressiva alienorum — a general paralysis of mads.
Atrophy of an optic nerve. Can be an independent form of neurosyphilis. Unilateral deterioration in sight which gradually extends also to the second eye is characteristic. Treatment of syphilis stops decrease in sight. A disease outcome at not treated patients is the blindness owing to an atrophy of an optic nerve.
Gummous syphilis. Gummas of a brain meet seldom. Favourite localization — the brain basis; is located in marrow less often. Leads to increase in intracranial pressure. The clinical current reminds that at a brain tumor with which it is necessary to carry out the differential diagnosis. The gumma of a spinal cord is more often localized in cervical or midthoracic department.

Neyrosifilis's reasons:

Etiology - a bacterium of a type of Treponema pallidum  (a pale treponema).

Neyrosifilis's treatment:

At treatment of neurosyphilis  drugs of penicillin the combination of peroral or intramuscular administration of antibacterial drugs to their endolumbar introduction and to the pyrotherapy increasing permeability of a blood-brain barrier is obligatory. Treatment of neurosyphilis drugs of a penicillinic row in Russia is problematic because of need of their endolumbar introduction, impossible in most institutions of dermatovenerologichesky service, due to the lack of the personnel having the rights for performance of similar manipulations now. Therefore there is a need of attraction to work with these patients of institutions of all-medical network. In some cases use of antibiotics of other groups having ability to get through GEB is justified. Now cephalosporins can be for this purpose used, however because of the current policy of the Ministry of Health of the Russian Federation use of alternative antibacterial therapy is accompanied by considerable procedural difficulties.