Meningovascular syphilis (tabes dorsalis)
After the invention of penicillin, such a disease as "tabes dorsalis" became less common in patients with syphilis than it was in the pre-penicillin era of mankind. The diagnosis of meningovascular syphilis should be borne in mind when differentiating the diagnosis in the case of major neurological syndromes arising from diseases of the spinal cord. The most common symptoms of meningovascular syphilis are patient complaints of pain. The pains with tabes dorsal are quick and recurring. Pain occurs as a type of lumbago in the legs. Much less often, the pain of tabes dorsal can be felt by the patient on the face, back, chest, abdomen, and arms.
In half of the patients with tabes dorsalis, a gait disorder of the type of gross ataxia appears. Ataxia is caused by a loss of position, which results in an imbalance that worsens when the eyes are closed (Romberg pose). In 15-30% of patients, sensitivity disorders of the type of paresthesia are noted. Along with this, there are disorders of the functions of the bladder, erectile dysfunction and delayed ejaculation in men, acute abdominal pain, and vomiting (visceral crises).
The most common symptoms of tabes dorsalis are:
- lack of tendon reflexes on the legs (Achilles tendon, knee jerk)
- disturbances in the sense of position and vibration sensitivity
- loss of balance when closing the eyes while standing (positive Romberg test)
- bilateral pupillary disorders - a symptom of Argyll Robertson (no constriction of the pupil when illuminated while maintaining their reaction to accommodation)
For the treatment of meningovascular syphilis of the spinal cord (tabes dorsalis), patients are prescribed intravenous penicillin in combination with other symptomatic drugs.