However, when the clinical picture is the same as in the case of our teamster, the alcohol may only be a complicating factor in neurosyphilis, as shown by our next case of the alcoholic steamfitter who in fact was shown to have Neurosyphilis.[[87]]
Sometimes cases of apparently frank alcoholism, even with apparently characteristic delirium tremens and neuritis, prove to be essentially neurosyphilitic.[[88]] On the other hand, true combinations of Alcoholism and Neurosyphilis occur which it would be proper to classify under either heading and in which therapy must take serious account of both conditions.[[89]]
As above stated, we elect to use the term pseudoparesis only for non-syphilitic cases. There are other forms of pseudoparesis than alcoholic pseudoparesis. The question of Diabetic Pseudoparesis is raised by an exceedingly complicated case of which our best interpretation is that the patient, a proved syphilitic (with syphilitic osteomyelitis (?)), a huge doorkeeper, was perhaps suffering from an old Syphilitic scarring of the Pituitary body.[[90]] Neither this case nor a second case, one of Paretic Neurosyphilis with glycosuria is actually entitled to the diagnosis diabetic pseudoparesis. The second case of paretic neurosyphilis with glycosuria brings up some unanswerable questions as to the pancreatic or basal meningitic or other origin for the glycosuria.[[91]]
Isolated symptoms are often presented by neurosyphilitics (e.g., hemianopsia);[[92]] but we tend to regard these cases as due to focal lesions that are merely part and parcel of Diffuse Lesions.
A neurosyphilitic case (a steward) with the rather unusual complication (for our northern region) of severe Malaria producing cerebral thrombosis is reported.[[93]]
The diagnosis Dementia Praecox[[94]] was actually made in the case of a young school-teacher in whom the laboratory findings proved conclusively that the condition was one of Neurosyphilis. The gold sol reaction in this case was mild. The chief lesion at autopsy was a fresh looking, gelatinous pial exudate over the spinal cord which turned out to contain an almost pure display of very numerous plasma cells.
The question of Lues Maligna[[95]] is brought up in a rectifier of spirits in whom the characteristic tremendous destruction of tissue, toxemia and failure to react to antisyphilitic treatment were illustrated. Moreover, this case had a trauma (cautery) to the tonsil, as in other cases of lues maligna.
A case somewhat suggestive of brain tumor, of neurosyphilis and of multiple sclerosis[[96]] turned out to be Multiple Sclerosis (the fluid showed a pleocytosis and a moderate amount of globulin with a paretic type of gold sol reaction).
As a foil to this case that we regard as multiple sclerosis, we present a second case with nystagmus, optic atrophy and spasticity in which the suspicion of multiple sclerosis might well be raised but which the tests demonstrated to be Neurosyphilitic.[[97]]
An even stranger imitation of well-defined non-syphilitic entities was presented by a case apparently of Huntington’s chorea[[98]] (except for absence of the hereditary taint) which case, however, proved to the surprise of all diagnosticians to be one of Neurosyphilis.