HEREDITARY SYPHILIS OI"l'HE NERVOtS SYSTEM Hereditary syphilis may attack ally portion of the central nervous system. The morbid symptoms may develop in the foetus, and in the early years of life, in late childhood and in adolescence. It is needless to say that intra-uterine changes of the central nervous system assume practical importance only when they clo not exclude the viability of the foetus; accordingly, the meningitic, encephalitic and myelitic changes which are observed in still-born and macerated foetuses i» the brain ancl particularly in the spinal cord (Gasne, Gangitano and a few unpublished reports) may be dismissed with a brief mention. It is possible that early syphilitic changes in the blood vessels may lead to imperfect develop ment of the brain and to malformations alberg). A greater interest attaches to the varied morbid phenomena which make their appearance in the first years of life and for which we have at our disposal an abun dance of pathological material. On the other hand, it is a noteworthy fact that in the first half year of life, when the various manifestations of hereditary syphilis are most marked, disease of the central nervous sys tem is quite rare; analogous to the well-known fact that organic changes of the nervous system are usually absent in the secondary stage of syphilis in adults. From the 10th to the 14th year inherited syphilis begins to manifest itself in a variety of clinical conditions, some of which are quite characteristic and the accurate study of which during child hood—I need only mention tabes and progressive paralysis—is a product of recent years. The recognition of these manifestations of Fournier's late hereditary syphilis may present considerable difficulty when the patient is no longer a child. Thus, nervous affections of a hereditary syphilitic character have been observed in individuals in the third decade of life.
Diseases of the nervous system are not CO111171011 in hereditary syphilis. Heubner gives them the seventh place in order of frequency among the organic diseases due to hereditary syphilis, affections of the heart and blood vessels, many of which are closely related to the nervous affections, occupying the sixth place. According to Rumpf nervous symptoms appear in about 13 1),.r cent. of all children affected with hereditary syphilis.
syphilis gives rise to a variety of changes in the nervous system, depending on the seat of the lesion and the nature of the pathologic proeesses that have procluced the injury. In the main, the pathologic findings may be subdivided into the following groups: 1. Syphilitic cndarteritis elleubner) occurs both in the vessels at the base of the brain and in the small vessels of the brain and spinal cord. The vessels appear thickened; the lumen is diminished, the inner coat shows deposits and the perivascular connective tissue is hypertrophic; sometimes -whole segments of some of the larger vessels may be completely obliterated (Chiari, Dowse, Kohts, Ileubner).
2. Disease of the outer and inner coverings of the central nervons sys tent is a peculiarity of hereditary syphilis. Inflammation of the meninges
(sometimes of a hremorrhagic character) in the form of diffuse and basal meningitis eSiemerling, Beittger, Jfirgens, Bechterew, etc.), or as a chronic localized process with gummatous infiltration and thickening of the meninges (especially the pia) is found not infrequently both in the brain and in the spinal cord. In the same way the ependyma of the ventricles and the eovering of the, ehorioid plexus may be attack61 by a chronic granulating inflammation (Sandoz), which produces an accu mulation of fluid within the ventricles in the form of hydrocephalus.
3. Eneephalotnalacia, encephalitis, particularly of the cerebral hemi spheres, and myelitis occur as the result either of the endarteritis or of tlw inflammation of the meninges, and may lead to the production of adhesion between the meninges and the nerve substance (meningo encephalitis), vascular neoplasms, proliferation of neurogliar tissue or degeneration of nerve fibres and cells.
4. Isolated gumtnata occur both in the cerebrum iCnopf) and in the spinal cord, but are not frequent. On the other hand, gummatous infiltration of the meninges, of the nervous tissues and of the cranial nerves is not rare.
5. In syphilitic affections of long standing, circumscribed or diffuse sclerotic processes often develop in the central nervous system. The diseased portions of the cerebrum become firmer than normal, the con volutions diminish in size and may undergo pronounced atrophy (Bechterew, Busz, Shukowski, BuIlen, Jacobson, Moncorvo and others).
6. Apoplectic cerebral hantorrhage is rare (Nonne).
7. In the peripheral nervous sy,slcin, affections due to hereditary syph ilis are relatively rare; the nerves at the base of the brain may exhibit gummatous infiltration, degeneration and atrophy. Multiple neuritis has never been positively demonstrated post mortem in hereditary syphilis.
S. Finally, it is believed that parental syphilis may produce uni versal degeneration of the central nervous system without any well defined pathological findings, a degeneration which manifests itself in a variety of diseases known as parasyphilitic affections.
These pathological changes in the central nervous system are usually combined in a variety of ways—a peculiarity of diseases of thy central nervous system due to hereditary syphilis. Clinically this same tendency manifests itself in the production of a great variety of clinical pictures, second only in that respect to the endogenous diseases. Affections of the central nervous system due to hereditary syphilis often extend over many years and their clinical manifestations during this time may be subject to great change.
Accordingly no attempt will be made in the following presentation to give a complete picture of hereditary syphilis in the central nervous system, and only the most frequent symptoms and most important clinical conditions will be discussed.