Tabes Dorsalis: Difference between revisions
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== Clinical Presentation == | == Clinical Presentation == | ||
The neurologic presentation is one of ongoing loss of pain sensation, loss of peripheral reflexes, impairment of vibration and position senses, and progressive ataxia.<ref>Knudsen RP. Neurosyphilis: overview of syphilis of the CNS. Medscape Reference. 2011.</ref> The earliest stages of neurosyphilis involve inflammation of the meninges presenting with headache, nausea, vomiting, and, occasionally, seizures.<ref name=":0" /> | The neurologic presentation is one of ongoing loss of pain sensation, loss of peripheral reflexes, impairment of vibration and position senses, and progressive ataxia.<ref>Knudsen RP. Neurosyphilis: overview of syphilis of the CNS. Medscape Reference. 2011.</ref> The earliest stages of neurosyphilis involve inflammation of the meninges presenting with headache, nausea, vomiting, and, occasionally, seizures.<ref name=":0" /> There may be chronic destructive changes in the large joints of the affected limbs in far-advanced cases (i.e., Charcot's joints). Incontinence of the bladder and impotence are common. Sudden and severely painful crises of uncertain origin are a characteristic part of the syndrome.<ref>Hook EW. Goldman's Cecil Medicine (Twenty Fourth Edition), 2012.</ref> | ||
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== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Medical treatment involves penicillin, administered intravenously. Opiates, valproate and carbamazepine are some of the analgesics used in treating pain associated with Tabes dorsalis.<br> | Medical treatment involves penicillin, administered intravenously. Opiates, valproate and carbamazepine are some of the analgesics used in treating pain associated with Tabes dorsalis. Physiotherapy management includes Frenkel's exercise, strengthening exercises, balance retraining and use of assistive devices.<br> | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Revision as of 17:25, 18 July 2021
Top Contributors - Innocent Abugu, Kim Jackson, Kirenga Bamurange Liliane and Oyemi Sillo
Introduction[edit | edit source]
Tabes dorsalis is a slowly progressive degenarative disorder of the dorsal column and dorsal root of the spinal cord. Tabes dorsalis is caused by demyelination as a result of an untreated syphilis infection caused by Treponema pallidum. Treponema pallidum infection, if left untreated or partially treated, can lead to late neurosyphilis which has two forms, general paresis (also known as "syphilitic dementia," "dementia paralytica" or "paretic neurosyphilis") and tabes dorsalis (also known as "locomotor ataxia"). [1]It is more common in males than in females.
Clinically Relevant Anatomy
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Sensory information is transmitted through the dorsal (posterior) column of the spinal cord and through the medial lemniscus in the brainstem. The dorsal column-medial lemniscal pathway is responsible for conveying sensations of vibration, proprioception and fine touch (tactile sensation).
Mechanism of Injury / Pathological Process
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Treponemes are spirochetes, which are thin, delicate, helically coiled organisms measuring 5-20 µm in length.[2]Treponema pallidum can be transferred vertically from mother to fetus and through sexual intercourse.[3]
The disease usually involves three phases. The primary infection follows the inoculation of an individual with about 500–1000 bacteria. Within 36 h these replicate and result in a painless ulceration called a chancre. These typically occur in the genital areas. After 2–6 weeks the second stage of the disease continues, with wide infiltration throughout the body and nervous system. Afterward, during the latent stage of disease, patients are frequently asymptomatic for many years. About 10% of patients with untreated syphilis develop neurological symptoms called neurosphyilis, or tabes dorsalis, 10–15 years later. [4]
Clinical Presentation[edit | edit source]
The neurologic presentation is one of ongoing loss of pain sensation, loss of peripheral reflexes, impairment of vibration and position senses, and progressive ataxia.[5] The earliest stages of neurosyphilis involve inflammation of the meninges presenting with headache, nausea, vomiting, and, occasionally, seizures.[4] There may be chronic destructive changes in the large joints of the affected limbs in far-advanced cases (i.e., Charcot's joints). Incontinence of the bladder and impotence are common. Sudden and severely painful crises of uncertain origin are a characteristic part of the syndrome.[6]
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
Medical treatment involves penicillin, administered intravenously. Opiates, valproate and carbamazepine are some of the analgesics used in treating pain associated with Tabes dorsalis. Physiotherapy management includes Frenkel's exercise, strengthening exercises, balance retraining and use of assistive devices.
Differential Diagnosis
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add text here relating to the differential diagnosis of this condition
Resources
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add appropriate resources here
References[edit | edit source]
- ↑ Bhandari J, Thada PK, Ratzan RM. Tabes Dorsalis.
- ↑ Cintron R, Pachner AR. Spirochetal diseases of the nervous system. Current opinion in neurology. 1994 Jun 1;7(3):217-22.
- ↑ Fitzgerald TJ. Pathogenesis and immunology of Treponema pallidum. Annual Reviews in Microbiology. 1981 Oct;35(1):29-54.
- ↑ 4.0 4.1 Sontheimer H. Diseases of the nervous system. Academic Press; 2015 Mar 6.
- ↑ Knudsen RP. Neurosyphilis: overview of syphilis of the CNS. Medscape Reference. 2011.
- ↑ Hook EW. Goldman's Cecil Medicine (Twenty Fourth Edition), 2012.
