The white matter of numerous convolutions showed microscopically certain pale spots suggestive of an early atrophic process. Very possibly these represent a general tendency in the cerebrum to the same process of parenchymatous loss which had proceeded to such a marked degree in the spinal cord.
There was a single large so-called cyst of softening in the cerebellum (1.5 mm. across by 0.5–7.5 cm. in depth).
How far can we explain the symptoms of this case on the basis of these encephalic lesions? We can offer no correlation with the cerebellar lesion; and possibly this lack of correlation is to be expected on account of its failure to affect the vermis. As to the cystic lesions of the corpora striata, their effect in producing paraplegia at the close of life is obvious, and their possible relation to the partial return of knee-jerks has been discussed. Literally amazing was the comparative integrity of the cortical gray matter of this case when the spinal cord and the interior structures of the encephalon had been subjected to such severe and numerous lesions. The only mental symptoms noted in the case were sundry delusions directed against the patient’s relatives and a certain optimism which led the patient to cling as if with an obsession to the belief that in the end she would get well.
| VARIOUS FORMS OF NEUROSYPHILIS COLLECTED FROM SEVERAL SOURCES | |
| MENINGEAL NEUROSYPHILIS (M) | |
| GUMMA OF DURA MATER | M |
| GUMMATOUS MENINGITIS (Pial) | M |
| SYPHILITIC MENINGITIS (Pial) | M |
| SYPHILITIC CRANIAL NERVE PALSIES (Primarily Pial) | M |
| SYPHILITIC BULBAR PALSY | M |
| SYPHILITIC ROOT NEURITIS | M |
| SYPHILITIC TRANSVERSE MYELITIS | M |
| SYPHILITIC NEURITIS (Some Cases by Extension) | M |
| SYPHILITIC EPILEPSY (Some Cases) | M |
| SYPHILITIC MUSCULAR ATROPHY (Some Cases) | M |
| VASCULAR NEUROSYPHILIS (V) | |
| SYPHILITIC ARTERIOSCLEROSIS | V |
| SYPHILITIC CEREBRAL THROMBOSIS | V |
| SYPHILITIC APOPLEXY | V |
| ANEURYSM | V |
| SYPHILITIC EPILEPSY | V |
| PARENCHYMATOUS NEUROSYPHILIS (P) | |
| GUMMA | P |
| CEREBROSPINAL SCLEROSIS | P |
| SYPHILITIC PARANOIA | P? |
| SYPHILITIC CHOREA | P |
| SYPHILITIC EPILEPSY | P |
| TABETIC PSYCHOSIS | P? |
| SYPHILITIC MUSCULAR ATROPHY | P |
| SYPHILITIC NEURITIS | P |
| Chart 4a | |
| MENINGOVASCULAR NEUROSYPHILIS (MV) | |
| CEREBRAL SYPHILIS | MV |
| CEREBROSPINAL SYPHILIS | MV |
| SYPHILITIC EPILEPSY | MV |
| MENINGOPARENCHYMATOUS NEUROSYPHILIS (MP) | |
| CEREBRAL SYPHILIS | MP |
| CEREBROSPINAL SYPHILIS | MP |
| TABES DORSALIS | MP |
| ERB’S SYPHILITIC SPASTIC SPINAL PALSY | MP |
| VASCULOPARENCHYMATOUS NEUROSYPHILIS (VP) | |
| CEREBRAL SYPHILIS | VP |
| CEREBROSPINAL SYPHILIS | VP |
| PARETIC NEUROSYPHILIS (GENERAL PARESIS) | VP |
| LISSAUER’S GENERAL PARESIS | VP |
| MENINGOVASCULOPARENCHYMATOUS NEUROSYPHILIS (MVP) | |
| CEREBRAL SYPHILIS | MVP |
| CEREBROSPINAL SYPHILIS | MVP |
| PARETIC NEUROSYPHILIS | MVP |
| TABOPARESIS | MVP |
| DOUBTFUL (TOXIC?, IRRITATIVE?) NEUROSYPHILIS (?) | |
| “PARESIS SINE PARESI” | |
| SYPHILITIC NEURASTHENIA | |
| TABETIC PSYCHOSIS | |
| SYPHILITIC PARANOIA | |
| SYPHILITIC POLYURIA, POLYDIPSIA | |
| SYPHILITIC NEURALGIA | |
| Chart 4b | |
Summary: We have here dealt at length with a long-standing Diffuse Neurosyphilis affecting to some extent the entire meninges and producing a destruction of posterior column fibres and numerous other fibres of the spinal cord (tabetiform portion of the neurosyphilis picture). We have also found central lesions of the corpora striata affecting the destruction of both pyramidal tracts (paraplegic portion of the neurosyphilis picture). We have found evidences of acute inflammation (lymphocytosis) in the cervical region of the spinal cord and in the left eighth nerve (progressive inflammatory neurosyphilis picture). In short, we have presented a case of diffuse (meningovasculoparenchymatous) neurosyphilis characterized by an ascending character in a course of at least 16 years; we have indicated a number of possible clinical correlations, not only with the major portion of the clinical course (symptoms of myelitis and pyramidal tract destruction), but we have also mentioned, merely for their suggestive value, a number of finer correlations between histological findings and certain clinical features (notably transient losses of vision and hearing, and a partial return of the lost knee-jerks). Bearing in mind the clinical and anatomical findings of this case, we shall be able to discuss the cases that follow in a briefer and more condensed fashion.
TABETIC NEUROSYPHILIS (“tabes dorsalis,” “locomotor ataxia”) complicated by vascular neurosyphilis (hemiplegia). Autopsy.
Case 2. Francis Garfield had been a successful lumberman and had enjoyed good health until his forty-fifth year. Suddenly one day, while walking on the street, Garfield lost the use of his legs and for a time was quite unable to walk. However, he recovered locomotion and after a time there was nothing wrong with his leg movements except a slight ataxia.
At the age of 52 Garfield had to give up work. It appears that he had been becoming cranky, sometimes, for example, shouting, whistling and slamming doors, apparently to annoy the family. His intellectual capacity seemed to be maintained, although his memory was slightly impaired.
At 67 years there was an ill-defined seizure, followed a few days later by another seizure with aphasia (wrong words used and lack of understanding of things said).