The brain showed diffuse and focal changes. The diffuse process was one of nerve cell degeneration and proliferative changes in the neuroglia and blood vessels, and no section of the many examined proved to be free from such changes, although in the majority of instances, these diffuse changes were slight. The cortical layers showed more of these diffuse changes than did the white substance. Barrett considered that the glial cell changes were more delicate indicators of the cortical changes than the nerve cell changes. He found rod cells, satellitosis, superficial gliosis, and a large gamut of changes in the neuroglia. There were two rather characteristic nerve cell changes: a shrinkage change going on to almost complete destruction, and a type of cell swelling, also apparently proceeding to complete destruction.
4. Arteritis of pia mater.
5. Focal vascular lesions.
Case 57. Seven months from infection. “Disseminated syphilitic encephalitis,” Barrett. (Photographs by Barrett.)
Paretic neurosyphilis (“general paresis”)—cerebral atrophy, without meningitis. Therapeutics cannot hope to restore lost tissue.
Duration. 3 years from beginning of well marked symptoms; 6 years from beginning of obvious symptoms; 12 years from a so-called “nervous prostration.”
Among focal changes, there were four main types: Areas of encephalitis, having the general appearance of granulation tissue, areas of simple necrosis or softening, apparently directly related to vascular changes near by, hemorrhages, and certain foci regarded as gummatous.
Save for pial infiltration and a few vascular changes, there was very little change in the medulla and spinal cord. There was a hypertrophic gliosis of the margin of the medulla and cord throughout, and a focal lesion of well marked gliosis at one point in the bulb. There were no fibre degenerations in the medulla or cord, nor were there any coarse fibre degenerations in the cortex itself except in one locus, the left gyrus rectus. This case is of peculiar value in showing to what extent lesions may proceed in a period of six to eight months after primary infection.
Of course the case is in one sense entirely atypical. The lesions were not confined to the nervous system. Aside from the maculo-papular eruption and ecchymosis of the skin, there was a diffuse hemorrhage of the inner half of the conjunctiva of the left eyeball, a small hemorrhagic focus in the mitral valve, a caseous nodule, one cm. in diameter, in the apex of the left lung whose tuberculous or syphilitic nature is left in doubt; a broad milk-colored patch of thickening of the capsule of the liver. It is to be noted that there were no gross lesions of the aorta.