Congenital syphilis is also apparently capable of producing a simple form of Feeblemindedness,[[68]] that is to say, a form of disease non-paretic, non-tabetic, and without special tendency to vascular insults.
We present a case of Juvenile Tabetic Neurosyphilis (“juvenile tabes”).[[69]] The tests were all positive.
The line of separation between typical and atypical cases of neurosyphilis is vague and indistinct and some of the cases classified by us amongst puzzles perhaps belong under systematic diagnosis and vice versa. The section on PUZZLES AND ERRORS in the diagnosis of neurosyphilis is introduced by six cases of error in the diagnosis of the paretic form of neurosyphilis.[[70]] These errors were made known by autopsy. Aside from the sixth case, whose etiology must remain in doubt and which was a unique case of Perivascular Gliosis, there is ground for the belief that the other five cases in this Danvers Hospital study of diagnostic errors were perhaps actually syphilitic though not of the paretic form of neurosyphilis. At all events, the brain tissues in these cases failed to show the plasma cell deposits which are characteristic in the sheaths of the intracortical vessels in paretic neurosyphilis.
A case illustrates the complication of Tabes by arteriosclerotic symptoms, in which case the arteriosclerosis may naturally have been of syphilitic origin. Two cases especially illustrate the possibility of confusing the ataxia of general paresis with Cerebellar Ataxia. These cases showed lesions of the cerebellar structures, notably of the dentate nucleus. No one can read these cases or any of the autopsied cases in our series, without perceiving how fundamental and even critical is the demand for autopsies in fatal cases of neurosyphilis. The practitioner who can secure an autopsy in a fatal case of neurosyphilis and have the tissues worked up by approved neuropathological methods is almost bound to add his bit to neurological theory. Even cases of classical tabes dorsalis are often signally important to the theorist on account of the relations of the neural to the non-neural complications.
We then proceed to a group of cases without special order in which a variety of diagnostic questions arose.
A case of questionable neurosyphilis in the secondary stage of syphilis brings up the problems of syphilitic neurasthenia.[[71]]
Syphilis may act as agent provocateur of Hysteria as Charcot insisted.[[72]]
A case illustrative of difficulties in diagnosis between neurosyphilis and manic-depressive psychosis follows.[[73]]
A case for diagnosis is given which shows that errors in the diagnosis of neurosyphilis are entirely possible even when abundant clinical and laboratory data are available. A case with a weakly positive Wassermann reaction in the spinal fluid finally turned out to be one of Brain Tumor.[[74]]
Some questions as to the diagnosis of Neurosyphilis versus Idiopathic Epilepsy are brought up by a case in which phenomena of paresis seemed to have occurred very early, about two years after the initial syphilitic infection.[[75]]