A case of Paretic Neurosyphilis is offered in which hemiplegia and hemitremor strongly suggested vascular lesions; but the autopsy showed no coarse lesions and merely confirmed the diagnosis paresis microscopically.[[76]]
An autopsied case of Paretic Neurosyphilis is given, in which the pupils persisted in reacting normally. Herpes zoster-like lesions in life yielded no special signs at autopsy (all root-ganglia looked alike above and below zone of “shingles.”)[[77]]
An example of Neurosyphilis, probably Paretic, yielded symptoms highly suggestive of manic-depressive psychosis.[[78]] An interesting feature in this case was the birth of a healthy child nine months after the onset of the psychotic attack.
An example of exophthalmic goitre[[79]] following the acquisition of Syphilis showed at autopsy a heavy scarring of the optic thalamus and unilaterally atrophic process in the cerebral cortex.
We come to some questions concerning the Argyll-Robertson pupil. It is agreed on all hands that the Argyll-Robertson pupil is characteristic of the paretic and tabetic forms, but the sign occurs also in other neurosyphilitic conditions;[[80]] in fact the sign does not necessarily indicate neurosyphilis as an instance of Pineal Tumor demonstrates.[[81]]
The question raised above as to the possibility that neurosyphilis may exist in the absence of positive findings in the spinal fluid is illustrated in a man, a mechanic, who claimed syphilitic infection and showed an Argyll-Robertson pupil on one side.[[82]] The serum W. R. was positive; the fluid tests were negative.
An extraordinary case is given in some detail in which Neurosyphilis in the form termed Disseminated Encephalitis[[83]] proved fatal within seven months of the initial infection.
We have frequently mentioned the classical assumption that paretic neurosyphilis (“general paresis”) is a fatal disease. Some have suggested that there is another form clinically almost identical with general paresis except that it pursues a long course and the suggestion has been made that these cases be termed pseudoparesis.[[84]] We are of the opinion that this term should be dropped and advocate the use of the word pseudoparesis only for non-syphilitic disease looking like paresis, such as alcoholic pseudoparesis and the like.
The question whether there is a form of mental disease Syphilitic Paranoia[[85]] is raised by a case with auditory hallucinations, ideas of persecution and attacks of excitement. The diagnosis of alcoholic hallucinosis was actually made although there is no proof that the patient ever drank alcohol.
Alcohol may cause symptoms identical with those of paretic neurosyphilis, including seizures, Argyll-Robertson pupils, speech defect and mental symptoms. The differentiation is readily made by the negative laboratory findings. An illustration is given in our case of the alcoholic teamster. Cases such as this bear the name Alcoholic Pseudoparesis.[[86]]