To illustrate complications we give a case of Paretic Neurosyphilis with autopsy in which there were ante mortem signs of Herpes Zoster[[57]] or, at all events, of a skin eruption limited to the area of a thoracic nerve.
A case of Gumma of the brain[[58]] in which decompression was warranted and performed is presented. The fluid W. R., as in many such cases, was negative; serum positive.
A case of Cranial Neurosyphilis (extraocular palsy[[59]] without mental symptoms) showed a positive Wassermann serum test and a negative spinal fluid.
The laboratory reactions in Tabetic Neurosyphilis[[60]] (“tabes dorsalis”) run somewhat like those of diffuse non-paretic neurosyphilis and are accordingly milder than those of paretic neurosyphilis. The fluid W. R. and the gold sol reaction in particular are apt to run mild. The clinical course of tabes dorsalis is well known to be protracted and the prognosis quoad vitam is good except that we must always bear in mind the possibility of vascular insults and complications of a syphilitic origin in the rest of the body.
It is important to remember that Tabetic Neurosyphilis is often quite atypical[[61]] clinically and may even show no single symptom warranting the old clinical name locomotor ataxia.
There are even cases in which the name tabes dorsalis is not warranted in view of the fact that the lesions are not low in the cord but are higher up (Tabes Cervicalis[[62]]).
A rare form of neurosyphilis is Erb’s Syphilitic Spastic Paraplegia[[63]] against which one needs to consider a number of non-syphilitic spinal cord diseases. Our case showed a weakly positive serum W. R., a negative fluid W. R., and the other tests of the spinal fluid were moderately positive.
Syphilitic Muscular Atrophy[[64]] is classified by Head and Fearnsides both in their meningovascular group and in their group of the so-called syphilis centralis. Our case affecting in large part the small muscles of the hands in a teamster, may be due either to spinal parenchymal lesions or to root neuritis or to both.
It is a little extraordinary and very important that the laboratory signs are apt to be positive even in the Secondary period of Syphilis. Perhaps a third of all cases of syphilis in the secondaries would, if tested, yield positives precisely like those of full-blown paretic or diffuse neurosyphilis. Strangely enough, these signs may occur without clinical symptoms. The illustrative case,[[65]] a mechanic, yielded various mental symptoms. The cases of secondary syphilis with laboratory signs of neurosyphilis but without clinical symptoms are of the greatest theoretical importance in relation to the problem above mentioned of paresis sine paresi. It may well be inquired whether in some instances the neurosyphilis of the secondaries does not persist until the exhibition of mental or physical symptoms of neurosyphilis years later. It must be remembered that this conception is hardly more than a hypothesis at the present time. That such signs of chronic inflammation could exist without symptoms is not so surprising when one thinks of the startling immediate improvement seen after treatment or even in remissions without treatment. One is reminded of the crisis in pneumonia wherein clinical improvement takes place entirely independent of the mechanical conditions in the lung which just after the crisis remain as suppurative as before.
The diagnosis of Juvenile Neurosyphilis is made upon the same lines as that of neurosyphilis in the adult. We present two cases, one with optic atrophy[[66]] and the other with signs of congenital syphilis antedating the symptoms of paresis.[[67]]