Читать книгу Neurosyphilis. Modern Systematic Diagnosis and Treatment Presented in One Hundred and Thirty-Seven Case Histories онлайн

13 страница из 85

Bearing in mind the mingling of structural with functional symptoms in this case, let us consider the autopsy findings.

ANATOMICAL

FORMS OF NEUROSYPHILIS

AUTONOMIC (SYMPATHETIC) NEUROSYPHILIS?

PERIPHERAL NEUROSYPHILIS

CENTRAL NEUROSYPHILIS

MENINGEAL

VASCULAR

PARENCHYMATOUS

MENINGOVASCULAR

VASCULOPARENCHYMATOUS

DIFFUSE ( = MENINGOVASCULOPARENCHYMATOUS)

GUMMA

Chart 1

CLINICAL FORMS OF NEUROSYPHILIS

HEAD AND FEARNSIDES, 1914

SYPHILIS MENINGOVASCULARIS

CEREBRAL FORMS

HEMIPLEGIA

AFFECTION OF THE CRANIAL NERVES

MUSCULAR ATROPHY

LATERAL AND COMBINED DEGENERATIONS

EPILEPSY

SYPHILIS CENTRALIS

DEMENTIA PARALYTICA

TABES DORSALIS

MUSCULAR ATROPHY

OPTIC ATROPHY

GASTRIC CRISES

EPILEPTIC MANIFESTATIONS

Chart 2

Peripheral neurosyphilisright third nerveright sixth nerveleft seventh and eighth nervesoptic nerves

How much of the transient blindness, deafness, and ocular paralysis can be explained on the anatomical findings in these nerves? Possibly a portion of the phenomena can be so explained. Thus, the mechanical conditions of pressure inside and outside these nerves, both in their peripheral course and in their passage through the membranes, can be readily understood to differ during the acute and subacute inflammation, during the process of repair in the pial tissues, and during the process of overgrowth of neuroglia tissue about the superficial origins of the nerves. Of course, the majority of lesions of these nerves were entirely extinct at the time of the autopsy, and their history could be surmised only from the appearances in the left eighth nerve. Here occurred a sharply marked focal area of gliosis with apparently total destruction of nerve fibres and related with a lymphocytosis of the investing membrane (one of the few areas of lymphocytosis found anywhere in this case).