F. CENTRAL NERVOUS SYSTEM SYPHILIS
Patients with syphilis may pass through a stage of asymptomatic syphilitic
meningitis with the CSF showing an increased cell count and positive serologic
reaction. A minority (10-20%) of patients will develop tertiary neurosyphilis
years later. There are 3 types of tertiary neurosyphilis,
which may occur alone or in combination.
- a. Pathology: Infiltration of meninges and vessels by lymphocytes
and plasma cells; may cause symptoms of meningitis or vascular occlusion.
- b. Clinical symptoms: similar to low grade meningitis and/or
"stroke" (due to vascular occlusion)
2. General Paresis:
- a. Pathology: Atrophy, loss of cortical neurons especially in
frontal lobes, gliosis, proliferation of microglial cells (rod cells), perivascular
lymphocytes and plasma cells. Spirochetes present in brain tissue.
- b. Clinical symptoms: mental changes, progressing to dementia;
3. Tabes Dorsalis:
- a. Pathology: Inflammatory lesions involving meninges and vessels
in subarachnoid space of dorsal nerve roots. Loss of axons and myelin in
dorsal roots with Wallerian degeneration of dorsal columns. (T. pallidum
absent in cord parenchyma.)
- b. Clinical symptoms: lightning pains; sensory deficits, including
loss of pain sensation and loss of position sense (leading to ataxia); Argyll-Robertson
pupils (react to accommodation but not to light)