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Symptoms of Syphilis of the Central Nervous System 1

hereditary, epilepsy, cerebral, brain, disease and convulsions

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SYMPTOMS OF SYPHILIS OF THE CENTRAL NERVOUS SYSTEM 1. Convulsions, Epilepsy.—Couvulsions arc frequent as con comitant symptoms in cerebral processes due to hereditary syphilis. They may usher in the cerebral disease, they may occur as secondary symptoms in severe affections involving the brain, or represent the termi nal stage in a protracted illness, and quite often the direct cause of death in children who are the subjects of hereditary syphilis. Occasionally they begin as unilateral convulsions. Cortical or Jacksonian epilepsy is quite characteristic of syphilitic diseases of the brain. Sometimes the motor spasm is preceded by sensory phenomena, formication or the sensation as if the part were going to sleep; in rare cases the attack is limited to manifestations of this kind (sensory Jacksonian epilepsy). The affected extremities sometimes become temporarily or permanently paralyzed. Attacks of cortical epilepsy may go on to general convulsions. Cortical epilepsy is due to disease of circumscribed portions of the cortex or of the meninges, such as often develops in hereditary syphilis; if the disease progresses and additional portions of the brain become involved, other cerebral symptoms are superackleci. Jacksonian epilepsy therefore usually represents merely one stage in the course of some severe cerebral lesion (Soltrnann, Kowalewsky, Fisch], etc.). Recurring convulsions like those which characterize genuine epilepsy not infrequently occur in hereditary syphilis. In an institution for the treatment of epileptics Bratz found that 5 per cent. of the 400 young inmates were the subjects of hereditary syphilis. Although, as a rule, epilepsy due to hereditary syphilis is accompanied by other cerebral symptoms such as disturbances of speech, tremors, rapidly progressing idiocy; apparently uncompli cated cases of epilepsy have also been observed in which a correct diagnosis was arrived at only as the result of treatment with potassium iodide (Fournier). Many otherwise typical cases of geniune epilepsy are regarded as parasyphilitic affections.

2. Headache is quite common, particularly in the later stages of syphilis. It may be the only symptom observed for a long time and sometimes assumes the character of hemicrania (Fournier, 1. IIalban).

3. Imbecility going on to complete idiocy i8 quite common in children who are the subjects of hereditary syphilis. It may be con genital or develop gradually. While in rare cases idiocy may be the only symptom (" parasyphilitic" disease), it is more frequently a.ssociated with other syphilitic symptoms, such as pupillary rigidity, convulsions and palsies, presenting either the picture of progressive paralysis (see below) or of a complicated brain syphilis. In children a disease which is accompanied by acquired progressive dementia should always arouse suspicion of syphilis.

4. Papillary riyidity.—Loss of pupillary reaction and particularly loss of reaction to light while that to convergence is preserved (Argyll Robertson pupil) is very characteristic of all forms of syphilitic processes and, barring rare cases of brain tumor and total blindness, practically always justifies the diagnosis of syphilis. In doubtful cerebral processes occurring in childhood this symptom decides in favor of syphilis. A sub ject of hereditary- syphilis may for years present pupillary rigidity as the only symptom of the prodromal stage of tabes or paralysis.

5. Ocular palsies—rarely of single muscles and then only tem porarily—occur in the course of cerebral diseases due to hereditary syphilis either as focal or as basal symptoms. Optic neuritis, choked disc, atrophy of the optic nerve and a ehorioretinitis which is charac teristic of syphilis also occur. Strabismus and nystagmus are frequently observed.

Palsies of other cranial nerves, especially of the facial, arc also quite common.

7. Speech disturbances of every variety, such as dysarthria, brady lalia, aphasia and as symptoms of diminished mentality are quite fre quently observed in hereditary- syphilis of the central nervous system.

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