Tabes dorsalis


Tabes dorsalis

Description, Causes and Risk Factors:

Tabes dorsalis is a convenient label for a complex group of neurological symptoms and signs caused by syphilis. The main lesions are in the posterior columns of the spinal cord, and the symptoms are therefore sensory. But there are also lesions affecting the autonomic nervous system, whose effects are on the viscera, the pupils of the eyes, and the limbs. In addition, this chronic, painful, and disabling disease, associated with syphilis, has a profound effect on the patient's mind.

Tabes dorsalis is caused by demyelination secondary to an untreated syphilis infection. The infection damages the tissue of the spinal cord and peripheral nervous tissue. This causes decreased muscle function (myelopathy), including progressive weakness of the legs, arms, and other areas. Loss of function may eventually result in paralysis.

Coordination difficulties contribute to problems walking. There are often changes in sensation, including painful paresthesia (abnormal sensations), which are also referred to as "lightning pains."

The disease is more frequent in males than in females. Onset is commonly during mid-life. The incidence of tabes dorsalis is rising, in part due to co-associated HIV infection. Tabes dorsalis is a serious condition. If left untreated, it can lead to paralysis, dementia, and blindness. Furthermore, even with treatment, existing nerve damage cannot be reversed.

Symptoms:

General symptoms may include:

    Lightning pains.

  • Visual symptoms (falling vision, ptosis optic atrophy, etc).

  • Difficulty in urination-Trouble in starting,dribbling afterward, nocturnal frequencyand " bed-wetting"

  • Paresthesia (numbness, prickling, girdlesensation, etc).

  • Ataxia.

  • Strabismus.

  • Diplopia.

  • Girdle sense.

  • Visceral crises (gastric, rectal, laryngeal).

  • Loss of libido and potential.

  • Vertigo.

  • Deafness.

  • Miscellaneous, including muscle atrophy,tabetic clubfoot, wrist and foot drop,hyperextensibility of joints (decreased muscle tone).

Signs may include:

    Argyll Robertson pupils.

  • Reduced or absent lower cord reflexes.

  • Romberg sign.

  • Sensory disturbance and dissociation.

  • Diminished pain.

  • Diminished vibration sense (bone forkconduction).

  • Diminished sense of motion and position.

Diagnosis:

Tests may include the following:

CSF (cerebrospinal fluid) examination.

  • Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases.

  • Serum VDRL or serum RPR (used as a screening test for syphilis infection -- if it is positive, one of the following tests will be needed to confirm the diagnosis):FTA-ABS, MHA-TP.

Elevated white cells and protein in the CSF with a positive CSF VDRL test in a person with appropriate clinical findings is diagnostic for tabes dorsalis.

Treatment:

The treatment of tabes dorsalis would be two fold and these will include the medical treatment as well as physical rehabilitation.

When it comes to medical treatment, penicillin, administered intravenously, is the treatment of choice. Associated pain may be treated with opiates, valproate sodium, or carbamazepine. Patients may also require physical or rehabilitative therapy to deal with muscle wasting and weakness. Preventive treatment for those who come into sexual contact with an individual with tabes dorsalis is important.

Physical rehabilitation would also be rather essential as these individuals will need training to make use of the weakened muscles and to gain useful functionality following an episode of tabes dorsalis.

But, even with such medications and physical therapy, one should remember that, existing neurological damage cannot be reversed and some sort of impairment could persist in the long run.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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