Those who suffer from syphilis are exposed in much greater proportion than are other persons to the ill effects of intemperance, sexual excesses, poverty, mental agony, and other well-established causes of general paralysis. It may be that in this is sufficient explanation of the frequency of general paralysis in syphilitics, but I incline to the belief that syphilis has some direct effect in producing the disease. However this may be, I think we must recognize as established the opinion of Voisin,67 that there is a syphilitic periencephalitis which presents symptoms closely resembling those of general paralysis. Such cases are examples of the pseudo-paralysie générale of Fournier.68
67 Paralysie générale des Alienés, 1879.
68 La Syphilis du Cerveau, Paris, 1879.
The question as to the diagnosis of these cases from the true incurable paresis is of course very important, and has been considered at great length by Voisin,69 Fournier,70 and Mickle.71
69 Loc. cit.
70 Loc. cit.
71 Brit. and For. Med.-Chir. Review, 1877.
The points which have been relied upon as diagnostic of syphilitic pseudo-general paralysis are—
The occurrence of headache, worse at night and present amongst the prodromes; an early persistent insomnia or somnolence; early epileptiform attacks; the exaltation being less marked, less persistent, and perhaps less associated with general maniacal restlessness and excitement; the articulation being paralytic rather than paretic; the absence of tremulousness, especially of the upper lip (Fournier); the effect of antispecific remedies.
When the conditions in any case correspond with the characters just paragraphed, or when any of the distinguishing characteristics of brain syphilis, as previously given, are present, the probability is that the disorder is specific and remediable. But the absence of these marks of specific disease is not proof that the patient is not suffering from syphilis. Headache may be absent in cerebral syphilis, as also may insomnia and somnolence. Epileptiform attacks are not always present in the pseudo-paralysis, and may be present in the genuine affection; a review of the cases previously tabulated shows that in several of them the megalomania was most pronounced; and a case with very pronounced delirium of grandeur, in which the autopsy revealed unquestionably specific brain lesions, may be found in Chauvet's Thesis, p. 31.