Congenital Neurosyphilis, Gumma of the Central Nervous System and Slow Virus Infections
The stigmata present at birth include hydrocephalus, mental retardation, seizures, chorioretinitis, optic atrophy, and nerve deafness. These can be connected with different evidences of congenital syphilis. Neurological management developing later in congenital syphilis normally takes the kind of meningovascular lesions, optic atrophy, tabes dorsalis or GPI. The late parenchymal lesions occur at a much younger age (juvenile GPI, juvenile tabes).
Diagnosis: Neurosyphilis might be of interest in the differential diagnosis of all neurological problems. GPI has to be differentiated from cerebrovascular problems, primary dementias, intra cranial space occupying lesions and progressive chronic lesions. Tabes dorsalis must be viewed in the differential diagnosing of lesions including diabetic, nutritional and toxic neuropatheis, heredofamilial, ataxias and syringomyelia. Presence of Argyll Robertson pupil is a very good point to allow for the diagnosis of neurosyphilis.
Laboratory diagnosis; Blood serology is good in 60-70 % of cases. The CSF changes are existing in a lot of. These include lymphocytic pleocytosis, increase in proteins and also a good Lange’s colloidal gold curve (which may be tabetic or paretic). The CSF changes depend on the activity of the illness. Previous treatment has a tendency to minimize the abnormalities.
Prognosis: Treatment may clear up meningovascular lesion completely. The results are very poor in established cases of tabes and optc atrophy. In GPI extensive improvement may occur.
Treatment: Penicillin is given. Repeated courses are generally required and this also has to be decided depending upon blood as well as CSF serology repeated at 6 as well as 12 weeks after initial therapy. Tabetic pains may react to carbamazepine and analgesics in a dose of 100mg thrice daily. Visceral crises are treated Nervexol by Oceanside (www.homernews.com) sedation and supportive measures.
Gumma of the main nervous system
Gumma takes place in the 3rd stage of syphilis. Pathologically, the gumma contain collagen deposition developing an amorphouse matric with lymphocytes as well as plasma cells at the periphery and multinucleated huge cells in the center. T.Pallidum isn’t demonstrable within these lesions. Gumma may be seen in a variety of situations cranial, leptomeningeal, dural, spinal and cerebral. These behave as space occupying lesions. response to antisyphilitic care is poor. Line of management is usually to excise the lesions and give antisyphilitic therapy.
Syphilitic deafness: Deafness may well result from a number of reasons in the various stages of syphilis. It might come from fondness of the cochlea, acoustic nerve, basal meninges or harm to the middle ear.
Gradual virus infections