Syphilis; neurosyphilis

Описание: Neurosyphilis is a manifestation of the tertiary stage of syphilis
Occurs in only about 10% of individuals with untreated infection.
Affected individuals often show incomplete or mixed pictures
Most commonly the combination of tabes dorsalis and Paretic disease (Taboparesis).
Individuals infected with HIV are at increased risk for neurosyphilis,
Particularly as an acute syphilitic meningitis or meningovascular disease.
This is because of impaired cell-mediated immunity.
The severity and rate of progression of the disease seem to be accelerated
Possibly for the same reason.
Chronic meningitis
Involves the base of the brain and more variably the cerebral convexities and the spinal leptomeninges.
Cranial and peripheral nerve compression
B-Obliterative endarteritis (Heubner arteritis)
Is accompanied by a distinctive perivascular inflammatory reaction rich in plasma cells and lymphocytes.
Meningovascular
syphilis
Occurs, on average, 7 yrs. after the initial infection.
The most common presentation is a stroke syndrome in a relatively young adult. The stroke syndrome involves the middle cerebral artery (most common)or the branches of the basilar artery (second most common).
A subacute encephalitic prodrome is present, with
headaches,
vertigo,
insomnia,
and psychological abnormalities e.g. personality change,
emotional liability,
decreased memory),
followed by a gradually progressive vascular syndrome.
Tabes dorsalis is the result of damage by the spirochetes to the sensory nerves in the dorsal roots and dorsal root ganglia with corresponding atrophy in the dorsal columns of the spinal cord.
Locomotor ataxia is the inability to precisely control one’s own bodily movements.
Persons affected with this disease may appear to walk like defective robots or otherwise move like malfunctioning machinery;
that is to say, in a herky-jerky, up-and-down kind of rhythmical but non-fluid manner
The Romberg test is a test of the body's sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord
Transient lightning pain of stabbing nature in legs;
Progressive loss of muscular co-ordination leading to clumsy, stumbling gait;
Inability of sense of pain, limb-position and temperature;
Partial or full loss of bladder and bowel control.
Argyll-Robertson Pupils is a classical eye finding in Tabes dorsalis & G.P.I.
Bilateral asymmetrical involvement
Small irregular pupils
Preserved vision
-ve light +ve to near reflexes
Site of the lesion :dorsal midbrain, Pre-aqidactal.

There is loss of both axons and myelin in the dorsal roots (arrows) and ganglia with corresponding pallor and atrophy in the dorsal columns of the spinal cord. stained for myelin.
Paretic neurosyphilis is caused by invasion of the brain by Treponema pallidum
Cerebral atrophy most prominent in frontal lobes. is seen in General paresis.
Microscopic Examination
Inflammatory lesions are associated with parenchymal damage in the cerebral cortex (particularly the frontal lobe but also affecting other areas of the iso-cortex) characterized by:
loss of neurons,
Proliferations of microglia (rod cells), gliosis,
and iron deposits.
Damage to the ependymal lining and proliferation of subependymal glia, called “granular ependymitis” in the ventricular wall (H&E).

F. The spirochetes can, at times, be demonstrated in tissue sections (silver stain).
Clinically manifested as insidious but progressive mental deficits
Is a severe manifestation of neurosyphilis.
It is a chronic dementia which ultimately result in death in 2 to 3 years.
Patients generally have progressive personality changes
Delusion of grandeur
hallucinations
Speach changes: decreased language ability (aphasia)
Decreased motivation
Impaired judgment
Loss of ability to calculate
Loss of long-term memory (long-past events)
Loss of short-term memory (recent events)
Muscle weakness (difficulty using legs, arms, or other parts of the body)
Seizures
Rarely, they have Psychosis, depression or mania.