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Purpose: To present a rare case of neurosyphilis, the tertiary form of syphilitic infection, following adequate but belated treatment and manifesting with a variety of clinical signs and further progression to tabetic neurosyphilis. Known as the "great imitator", neurosyphilis is often misdiagnosed and underestimated. Materials/methods: A 48-year-old male patient was admitted to the Neurology clinic of UMHAT "Dr Georgi Stranski" Pleven, Bulgaria, with progressive neurological deficit including numbness in the lower limbs, imbalance and wide-based gait. The T2W- MRI showed abnormally high longitudinal signals at Th12-L1 level, consistent with transverse myelitis. CSF analysis revealed leucocytic pleocytosis, elevated proteins and normal glucose. The nerve conduction studies confirmed sensory motor polyneuropathy. Results: After treatment with intravenous aqueous crystalline (IV) penicillin, 2 million intravenously every 4 hours for 20 days, the sensory symptoms reduced. The coordination disturbances persisted, but the gate showed moderate improvement. Conclusions: The diagnosis of syphilitic myelitis, known as tabes dorsalis, is always complex, not only because of its rarity but because of its unique clinical presentation with multiple clinical symptoms, mimicking other more common neurological disorders. Though confirmation of the diagnosis needs a lot of laboratory and neuroimaging studies, the option of effective specific treatment is worth all the efforts.

Zhou Zhu,1– 3,* Huizi Gong,4,* Mingjuan Liu,1– 3 Hanlin Zhang,1,2 Leyan Yang,1,2 Xinyi Zhang,5 Heyi Zheng,1,2 Yanfeng Li,6 Mingli Li,7 Jun Li1,2 1Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 3 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 4Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Departments of Internal Medicine and Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA; 6Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 7Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mingli Li, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People’s Republic of China, Email limingli@pumch.cn Jun Li, Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, People’s Republic of China, Email lijun35@hotmail.comBackground: Tabes dorsalis is a late manifestation of neurosyphilis, characterized by progressive ataxia, lightning pains, loss of proprioception, and urinary incontinence. The absence of a definitive diagnostic standard and the non-specific clinical manifestations have led to a significant rate of misdiagnoses.Methods: Hospitalized patients with tabes dorsalis at Peking Union Medical College Hospital between January 2010 and December 2023 were reviewed.Results: A total of 13 patients were included, with 10 males and 3 females. The median age was 50 years (range, 34– 64). The most frequent initial symptoms were limb numbness (30.8%) and lightning pains (30.8%). Eleven patients (84.6%) received misdiagnoses prior to the final diagnosis. The most frequently observed physical sign was positive Romberg’s sign (84.6%). Notably, Argyll Robertson pupil was presented in 7 subjects (53.8%). Serological tests revealed positive rapid plasma regain (RPR) and Treponema pallidum particle agglutination (TPPA) for all patients. All CSF samples were TPPA-reactive. Intramedullary hyperintensity on T2-weighted imaging of spinal MRI was found in 5 patients (38.5%). All patients received anti-syphilitic treatment, with effective treatment recorded in five cases.Conclusion: This study underscores the importance of neurological symptoms and signs in diagnosing tabes dorsalis. Individuals with progressive ataxia and positive Romberg’s sign should be closely monitored for potential neurosyphilis. Integrating clinical features, laboratory tests, and neuroimaging could reduce misdiagnosis and expedite the initiation of anti-syphilitic therapy.Keywords: tabes dorsalis, neurosyphilis, ataxia, cerebrospinal fluid

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Syphilitic myelitis is a neurodegenerative lesion caused by syphilis infiltrating the myelin sheath. A 49-year-old male patient visited the authors’ hospital complaining of weakness and sensory disturbance in both lower extremities that had occurred six months earlier. A physical examination revealed numbness of both lower extremities, a positive Romberg test, and an absence of deep tendon reflex. In a serological test, RPR (rapid plasma reagin) (>titer 1:20), FTA-ABS (fluorescent treponemal antibody absorption test), IgG (Immunoglobulin G) was positive. The findings included T2-weighted MR (magnetic resonance) images with high signal below T7, especially in the posterior column, and VDRL (venereal disease research laboratory) positive in the cerebrospinal fluid. At a follow-up six months after treatment, the laboratory test revealed improvement. Syphilitic myelitis, which showed symptoms after a long latent period, but with rapid progression, has not been reported and can easily be misdiagnosed at the initial diagnosis. The report of this case is intended to be helpful in the differential diagnosis of other myelopathy and myelitis. [ABSTRACT FROM AUTHOR]

Medical interest in the knee-jerk reflex began in about 1875 with simultaneous and independent publications by Wilhelm Heinrich Erb (1840–1921) and Carl Friedrich Otto Westphal (1833–1890) contending that the knee jerk was absent (and the ankle clonus was present) in all clear cases of locomotor ataxia (tabes dorsalis). Physicians in the medical communities of Europe, Great Britain, and North America responded with case and large group studies that tested this contention. These studies revealed the usefulness of the knee jerk and other myotatic reflexes, but also unexpected characteristics. The knee jerk, apparently so simple, proved to be a complex phenomenon depending the strength of the strike on the patella, induced muscle tension, and inhibition from the brain. Was it a reflex with afferent and efferent nerves and an intervening process in the spinal cord, or was it a local phenomenon confined to the muscle itself? Experimental studies directed at the reflex issue investigated latencies from patella strike to leg extension or muscle contraction and compared them with latencies from direct muscle strikes and theoretical calculations based on reflex components. Such studies were unable to resolve the reflex issue during the nineteenth century. The physicians were shown to be limited, like all scientific explorers of the unknown, by their knowledge, methodology, and technology. [ABSTRACT FROM AUTHOR]

As an internist, Wilhelm Erb (1840–1921) developed neurology (he also used the term "neuropathology" synonymously) in the tradition of his teacher, Nikolaus Friedreich, in Heidelberg. He left behind a huge corpus of semiological and nosological elements that now constitute our current knowledge of neurology, much more than just the eponyms associated with his name. In 1891, he founded the journal Zeitschrift für Nervenheilkunde [Journal of Neurology] together with internist-neurologist colleagues, thus creating the counterpart to the Archiv für Psychiatrie und Nervenkrankheiten [Archive for Psychiatry and Neurology], which was founded by Berlin neuropsychiatrists Wilhelm Griesinger and Carl Westphal. Despite his reservations about the Gesellschaft Deutscher Nervenärzte [Society of German Nerve Doctors], he was elected its first president in 1907. Erb was also one of the most important representatives of electrodiagnosis and therapy in Europe. He had many disciples who were part of the Heidelberg School of Neurology. His anti-Semitism—a widespread Zeitgeist phenomenon—was documented in several letters to his friend, neurologist Adolf von Strümpell, in which he expressed his contempt for the growing role of Jewish neurologists. Erb's retirement years were marked by illnesses, depression, and grief over the death of three of his sons. [ABSTRACT FROM AUTHOR]

DOI: 10.3969/j.issn.1672-6731.2019.05.013

Charcot spine arthropathy (CSA), a result of reduced afferent innervation, is an occurrence of Charcot joint, a progressive, degenerative disorder in vertebral joints, related mostly to spinal cord injury. The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. CSA presents with back pain, spinal deformity and instability, and audible spine noises during movement. Autonomic dysfunction includes bowel and bladder dysfunction. It is slowly progressive and usually diagnosed at a late stage, usually, on average, 20 years after the first initial insult. Diagnosis is rarely clinical related to the nature of nonspecific symptoms and requires imaging with computed tomography (CT) and magnetic resonance imaging (MRI). Conservative management focuses on the prevention of fractures and the progression of deformities. This includes bed rest, orthoses, and braces. These could be useful in elderly or frail patients who are not candidates for surgical treatment, or in minimally symptomatic patients, such as patients with spontaneous fusion leading to a stable spine. Symptomatic treatment is offered for autonomic dysfunction, such as anticholinergics for bladder control. Most patients require surgical treatment. Spinal fusion is achieved with open, minimally-open (MOA) or minimallyinvasive (MIS) approaches. The gold standard is open circumferential fusion; data is lacking to determine the superiority of open or MIS approaches. Patients usually improve after surgery; however, the rarity of the condition makes it difficult to estimate outcomes. This is a review of the latest and seminal literature about the treatment and chronic management of Charcot spine. The review includes the background of the syndrome, clinical presentation, and diagnosis, and compares the different treatment options that are currently available. [ABSTRACT FROM AUTHOR]

Syphilis is an increasingly diagnosed venereal disease which has four distinctive stages that may last over decades if appropriate treatment is not given. Review of the files of the Pathology Museum in the Faculty of Medicine at The University of Adelaide revealed three cases with classical cardiovascular and neurological findings. Case 1: An 80-year-old man with a large syphilitic aneurysm of the ascending aorta with a smaller aneurysm of the proximal descending aorta. Case 2: A 56-year-old man with chronic syphilitic meningoencephalitis with cerebral atrophy. Case 3: A 77-year-old man with tabes dorsalis. Given the increase in cases coming to medical attention in recent years due to high-risk sexual activity, migration, travel and reduced access to medical treatment, an awareness of the classical features of syphilis is appropriate as some cases will undoubtedly require medicolegal evaluation. [ABSTRACT FROM AUTHOR]

Objective To analyze the characteristics of clinical symptoms and imaging features of tabes dorsalis. Methods We retrospectively analyzed clinical signs and symptoms, laboratory examinations, imaging features, electrophysiological manifestations, treatment and prognosis of 3 patients with tabes dorsalis diagnosed in our hospital and 7 patients reported in literatures. Results The initial symptoms of 10 patients with tabes dorsalis included unsteady gait, pricking or lightning pain in abdomen and numbness of limbs (especially in both legs and feet). In addition to the above symptoms, the most common clinical features also included urination disorders, weakened or disappeared reflexes at knee and ankle, disorders of deep and shallow sensation, Romberg sign positive and heel-knee-tibia test instability. Treponema pallidum particle agglutination assay (TPPA) in serum of all patients was positive, and the titer of rapid plasma reagin (RPR) in serum was 1∶ 8-256. Cerebrospinal fluid (CSF) test showed increased white blood cell and protein. TPPA in CSF was also positive, and the titer of RPR in CSF was 1∶1-8. No obvious specificity of imaging changes was found except spinal disc degeneration. Some patients showed abnormal somatosensory-evoked potential (SEP) with prolonged latency and decreased amplitude of bilateral P100 waves, and the nerve conduction velocity (NCV) of most patients was normal. Six patients were improved after penicillin treatment. Conclusions Due to its complicated clinical manifestations and non-specific imaging changes, tabes dorsalis is prone to be misdiagnosed. A clear diagnosis depends on clinical signs and symptoms, laboratory examinations, imaging and electrophysiological manifestations. Only a minority of patients show imaging changes which are proved significant for the diagnosis of tabes dorsalis. DOI: 10.3969/j.issn.1672-6731.2016.07.006

Copyright of Dermatology Review / Przeglad Dermatologiczny is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Rates of syphilis are beginning to once again increase, with the World Health Organization estimating that in recent years there were 12 million new cases of syphilis each year; in 2002, syphilis was responsible for 0.3% of deaths globally. At‐risk groups include young males (20–29 years), prisoners, and sex workers. Increased rates in young females have elevated the numbers of congenital cases. Review of the University of Adelaide Pathology Archive revealed four cases with significant pathology, which included cardiac gummas and aortic arch aneurysms. These cases demonstrate the cardiovascular characteristics of untreated syphilis in the tertiary stage. Cases with such advanced pathology will only occur where diagnoses have not been made, and/or standard antibiotic therapy has not been implemented in the early stage of disease. [ABSTRACT FROM AUTHOR]

For decades syphilis and neurosyphilis were considered infrequent conditions; however with the advent of the human immunodeficiency virus the incidence of both diseases have increased. Neurosyphilis could be present in early or late stages of syphilis; the clinical manifestations are varied and will depend on the host response and the length of exposure to the spirochete; this could range from asymptomatic meningitis, to meningoencephalitis, strokes and more chronic conditions such as tabes dorsalis or syphilitic dementia. The key diagnostic approach is a high index of suspicion in patients with risk factors. The only presence of non treponemal studies is not diagnostic of neurosyphilis; it will be necessary to confirm it with treponemal serology and abnormalities in the cerebrospinal fluid (CSF) and positive VDRL and RPR in CSF. The cornerstone of treatment of neurosyphilis is still high doses penicillin and alternatively doxycycline or ceftriaxone. [ABSTRACT FROM AUTHOR]

Operative nerve-stretching was first described in 1872 to relieve incurable pain from sciatica and tabes dorsalis. It became popular for 20 years and numerous articles were published on the subject. It had many complications but relief was only transient and, consequently, it fell into disuse. This paper analyses the literature, contemporary views on the benefits of nerve stretching and its influence on more recent neurological practice. [ABSTRACT FROM AUTHOR]

Édouard Manet (1832-1883) is considered the 'father' of Impressionism and even of XXth century modern art. Manet's genius involved getting away from the classical narrative or historical topics and replacing them by the banality of daily life. Technically, he erased volumes into flat two-dimensional coloured planes, and distorted conventional perspective with often gross brushstrokes intentionally giving an 'unfinished' aspect to the work. It is little known that Manet had a very painful second part of his life, due to excruciating limb and chest pains, which developed in parallel with proprioceptive ataxia and gait imbalance. Manet always remained discreet about his private life, and we mainly know that his future wife was his family piano teacher, with whom he had a liaison already at age 17. Later, the great but platonic passion of his life was the painter Berthe Morisot (1841-1895), who got married to Manet's brother Eugène. In fact, we do not know whether he had any mistress at all, although he had several elegant 'flirts' in the mundane and artistic milieu . Thus, while Manet's progressive painful ataxia from age 40 yields little doubt on its tabetic origin, how he contracted syphilis at least 15-20 years before will probably remain a mystery. It is fascinating that Manet's daily struggle against pain and poor coordination may have led his art to become one of the most significant of modern times, opening the way to XXth century avant-gardes, along with another victim of syphilis, Paul Gauguin (1848-1903). Manet never showed any sign of General Paresis, and like his contemporary the writer Alphonse Daudet, his clinical picture remained dominated by paroxysmal pain and walking impairment. Difficult hand coordination made him quit watercolor painting, and during the last 2 years of his life, he had to focus on small format oil works, whose subject was nearly limited to modest bunches of fresh flowers, now often considered to be his maturity masterpieces. Having become bedridden, he had to be amputated of one leg, which was developing gangrene probably associated with ergot overuse. While he died shortly thereafter, we have some witness anecdotes suggesting that he experienced a phantom limb: when Claude Monet (1840-1926) visited him and sat down on his bed, Manet violently shouted at him that he was just sitting on his (absent) leg, which provoked terrible pains. With its facts and mysteries, the subtle interaction between Manet's illness and his work output remains one of the most intriguing stories in neurology of art. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orthopaedics, Trauma & Rehabilitation is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 30 year old female patient was presented with a history of weakness of both lower Limbs, sense of imbalance while standing and difficulty in walking with no significant past history. Upon investigation for paraperesis, the patient found to have a positive serology for syphilis. The possibility of neurosyphilis was considered, which was later confirmed by positive serology for cerebrospinal fluid and diagnosed as tabes dorsalis. The case is lengthly discussed in this report to emphasize the presence of syphilis in 21st century and for awareness of florid manifestations of tabes dorsalis for early diagnosis and proper treatment of this disabling condition.

Objective Neurosyphilis can present with a wide range of neuropsychiatric symptoms. Hence, psychiatrists need to be familiar with tests for syphilis screening and how to interpret syphilis serologic tests. Methods We present four cases of patients with positive syphilis tests encountered in a psychiatric hospital. Results Two cases were treated for neurosyphilis, while the other two cases did not have active syphilis infection despite positive results. Conclusion We thus highlight the challenges encountered by psychiatrists in screening for and diagnosing cases of neurosyphilis. [ABSTRACT FROM AUTHOR]

In 1899 the British Medical Journal enthusiastically announced that a new postgraduate teaching college was to open in London. The aim of the Medical Graduates’ College and Polyclinic (MGC) was to provide continuing education to general practitioners. It drew upon emerging specialisms and in so doing built upon the generalist training received at an undergraduate level. Courses were intended to refresh knowledge and to introduce general practitioners to new knowledge claims and clinical practices. The establishment of postgraduate institutions such as the MGC marked an important stage in the development of medical education in England. Yet these institutions, and the emergence of postgraduate medical education more broadly, have been largely overlooked by historians. Moreover the history of venereological training among medical undergraduates and postgraduates alike has been overlooked. The study of such special subjects characterised postgraduate study. This article examines the dissemination of venereological knowledge among subscribers to MGC as an important case study for the development of institutionalised postgraduate medical education in England at the turn of the twentieth century. [ABSTRACT FROM PUBLISHER]

Born of expatriate parents in Bombay, India, in 1865, Rudyard Kipling was the first English author to win the Nobel Prize for literature. He received this honor when he was not yet 42 years old. Indeed, Kipling’s career is remarkable for its precocious success. His collection of verse Departmental Ditties was published when he was 20 years old. When he first went to England in 1889, he was already a well-known writer.

Introduction: Tract-specific myelopathies with distinctive imaging features are uncommon and typically occur with metabolic or paraneoplastic syndromes. We report a unique case of tract-specific myelopathy with neurosyphilis., Case Presentation: A 53-year-old male presented with a four-month history of flaccid quadriparesis, sensory loss, and bladder dysfunction. His MRIs revealed striking symmetric T2-weighted hyperintensities in the lateral corticospinal tracts and dorsal columns of the cervical spinal cord that extended rostrally into the pyramidal decussation and medial lemnisci of the medulla oblongata. Nerve conduction and needle electromyography studies excluded axonal or demyelinating lower motor neuron disorders. The patient reported previous untreated primary syphilis and was seropositive on the T.pallidum hemagglutination assay. Penicillin therapy resulted in substantial clinical improvement., Discussion: Although syphilitic meningomyelitis is well-reported, our patient was unique because of the persistent flaccidity (possibly suggesting prolonged spinal shock) and striking tract-specific MRI patterns. These features are novel in syphilitic myelitis and suggest unknown mechanisms of tract-specific tropism and neuronal injury., Conclusions: "Tract-specific" complete transverse myelopathy with persistent flaccid weakness and areflexia is a novel presentation of neurosyphilis. Early recognition and crystalline penicillin therapy can alleviate morbidity. Our report describes this patient's findings and discusses the differential diagnoses of tract-specific myelopathies., (© 2023. The Author(s), under exclusive licence to International Spinal Cord Society.)

John Goodsir, conservator and professor of anatomy at the University of Edinburgh, suffered an unidentified illness described by experts after his death as tabes. The features that led to this diagnosis, the understanding of tabes at that time and its relationship in some cases to syphilis, are discussed. It is concluded that the most likely diagnoses are subacute combined degeneration of the cord as a result of malnutrition or tabes dorsalis resulting from earlier syphilis. The presence of 'lightning pains' leans towards the latter diagnosis but evidence for a means of acquisition of syphilis is lacking. The disadvantages of retrospective diagnosis are discussed.

Uncommon forms of syphilis exist, among which neurosyphilis, otosyphilis, and ocular syphilis are included. Neurosyphilis is the infection of the central nervous system caused by Treponema pallidum. The clinical manifestations of neurosyphilis are diverse and include early, late, and atypical forms. Syphilis can affect virtually any ocular structure and can occur at any stage of the disease, as well as otosyphilis. The diagnosis of these conditions is often challenging. However, it is important to consider them as a differential diagnosis, as most of these clinical manifestations are reversible with appropriate antibiotic treatment. A case series study of patients diagnosed with neurosyphilis, otosyphilis, and ocular syphilis, who were admitted to a tertiary-level hospital, is here presented: syphilitic meningitis with cranial nerve involvement, and seizures (case 1), ocular syphilis (case 2), general paresis (case 3), and tabes dorsalis (case 4). Half of the patients presented bilateral sensorineural hearing loss; and also half of the patients had reactive VDRL in cerebrospinal fluid. All were treated with aqueous penicillin G, and in two of these cases, ceftriaxone was chosen to complete ambulatory treatment. One patient had an unfavorable outcome and died (case 1); another was lost in follow-up (case 4); one completely resolved his symptoms (case 2); and another one experienced symptom relapse six months after treatment (case 3).

Background: Suspension therapy was developed by a Russian doctor, A. Motschutkovsky and at the end of the 19th century it was a popular treatment for tabes dorsalis. It was endorsed by Jean-Martin Charcot in France and Weir Mitchell in the United States; but after 10 years, it was abandoned because it proved to be useless and some patients developed paralysis. Summary: The effect of suspension upon a spinal cord affected by tabes dorsalis and a healthy spinal cord has been analyzed in the light of current knowledge. The benefits of suspension were thought to be due to an improvement in the blood supply to the spinal cord and due to the suggestibility or the placebo effect. Key Message: Analysis of the contemporary literature in the light of current research shows that suspension therapy was a powerful weapon that could cause impairment to the conductivity of the spinal cord and this has important implications for current therapy such as the use of Harrington rods. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]