A system of practical medicine. By American authors. Vol. 5

by Unknown

A tumor of the brain, if not attended with the common symptom of vomiting, may be the cause of convulsions and headache resembling those often seen in general paralysis. Optic neuritis or atrophy is usual in cerebral tumor, but rare in a stage of general paralysis so early that the diagnosis might be doubtful.

Hemorrhagic pachymeningitis also now and then simulates an obscure case of general paralysis in the early stage, but a few weeks at most settle any doubts in the matter.

Although diffuse cerebral syphilis is more apt to be associated with distinctly localized symptoms than the demented form of general paralysis, and although it is characterized by a mental apathy and physical torpor which follow a more regular course with more definite symptoms, resulting in a slow decay, yet there may be doubtful cases in which the differential diagnosis is impossible, and in which antisyphilitic treatment does not throw any light on the subject. Syphilitic new growths, endarteritis, and meningitis may so far improve from the use of mercury or the iodide of potassium as to end in an apparent cure, but in those cases the symptoms are not so marked as to make an exact diagnosis always possible. A distinct syphilitic cachexia is presumptive evidence of syphilitic encephalitis when there is doubt whether the syphilis is the cause or the diathesis.

Profound melancholia is not so often as varying gloom or moderate despondency a symptom of general paralysis. When it is such, there are developed in time the other marks of that disease, and it will only be necessary to hold the diagnosis in reserve for their appearance. The melancholia masks the dementia unless it is very carefully sought for, and the tremor may be as marked in melancholia as in the early stage of general paralysis, but more universal.

Acute mania is not uncommonly mistaken for general paralysis, when, as often happens, the delusions are as expansive and the tremor as great in the mania as in general paralysis; and it may be several months before the differential diagnosis can be made with certainty. In the presence of a high degree of maniacal excitement, with great emotional agitation and muscular tremor, it is difficult to establish the fact of the existence or not of dementia in doubtful cases until it is well developed. Acute mania has been known to constitute the prodromal period of general paralysis for a number of years.

Primary mental deterioration cannot be always differentiated from general paralysis of the demented type in its early stage. After the age of sixty the probabilities are in favor of primary mental deterioration in doubtful cases, but general paralysis occurs—seldom, to be sure—up to the age of sixty-five.

Early senile dementia may simulate general paralysis of the subacute form, but has not its clinical history. General paralysis of the quiet, insidious type and primary mental deterioration have been called premature senility. The three diseased conditions have certain points of similarity, and the pathological processes involved in them do not differ sufficiently to authorize the assumption that they are not closely related, if not simply variations, due to age and other causes, in one morbid process.

Finally, the mental impairment caused by the prolonged use of bromide of potassium and hydrate of chloral has been mistaken for general paralysis, until a critical examination unmistakably showed the presence of the well-known symptoms of those drugs.

In examining the patient it is especially important to avoid leading questions, as in general paralysis and in those conditions which simulate its early stage the mind is in a condition to readily fall into the train of thought suggested to it. The fact should be kept in mind, too, that the symptoms in early general paralysis are so variable as to be sometimes quite evident, and at other times not to be got at with certainty at all or only after long and patient examination; that they sometimes quite disappear under the influence of complete mental and bodily rest; and that in all stages, until near the end, such complete remissions may occur as to make the diagnosis, independent of the history of the case, difficult if not impossible.

A gentleman once committed an offence characteristic of general paralysis in marrying a pretty servant-girl while temporarily away from his home. His wife, daughters, and friends saw that the act was so contrary to his natural character that he was placed in an insane asylum and kept there several weeks under observation for an opinion as to his responsibility. He appeared so well in the absolute quiet and rest that he was declared sane, tried, and sentenced to the State prison, where he showed his marked mental impairment as soon as he was set to work. He could not concentrate his mind sufficiently for the simplest labor, and a couple of years later he was sent to the insane asylum to die, a complete mental and physical wreck, in the late stage of general paralysis.