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| Tabes dorsalis | |
|---|---|
| Other names | Syphilitic myelopathy |
 | |
| Axial section of the spinal cord showing syphilitic destruction (whitened area, upper center) of the posterior columns which carry sensory information from the body to the brain | |
| Specialty | Neurology |
Tabes dorsalis is a late consequence ofneurosyphilis, characterized by the slow degeneration (specifically,demyelination) of the neural tracts primarily in thedorsal root ganglia of thespinal cord (nerve root). These patients have lancinating nerve root pain which is aggravated by coughing, and features of sensory ataxia with ocular involvement.
Signs and symptoms may not appear for decades after the initial infection and includeweakness,diminished reflexes,paresthesias (shooting and burning pains, pricking sensations, andformication),hypoesthesias (abnormally diminished sense of touch), tabetic gait (locomotor ataxia), progressive degeneration of the joints,loss of coordination, episodes of intense pain and disturbed sensation (includingglossodynia), personality changes,urinary incontinence,dementia,deafness,visual impairment, positiveRomberg's test, and impaired response to light (Argyll Robertson pupil). The skeletal musculature is hypotonic due to destruction of the sensory limb of the spindle reflex. The deep tendon reflexes are also diminished or absent; for example, the "knee jerk" orpatellar reflex may be lacking (Westphal's sign). A complication of tabes dorsalis can be transient neuralgicparoxysmal pain affecting the eyes and the ophthalmic areas, previously called "Pel's crises" after Dutch physicianP.K. Pel. Now more commonly called "tabetic ocular crises", an attack is characterized by sudden, intense eye pain,tearing of the eyes andsensitivity to light.[1][2]
"Tabes dorsalgia" is a related lancinating back pain.[citation needed]
"Tabetic gait" is a characteristic ataxicgait of untreated syphilis where the person's feet slap the ground as they strike the floor due to loss ofproprioception. In daylight the person can avoid some unsteadiness by watching their own feet.[citation needed]
Tabes dorsalis is caused bydemyelination by advanced syphilis infection (tertiary syphilis) when the primary infection by the causativespirochetebacterium,Treponema pallidum, is left untreated for an extended period of time (past the point of blood infection by the organism).[3] The spirochete invades large myelinated fibers, leading to the involvement of the dorsal column medial leminiscus pathway rather than the spinothalamic tract.[citation needed]
Routine screening for syphilis.Treponemal antibody usually positive both in blood and inCSF also.In CSF lymphocytosis and elevated protein found.Serological tests are usually positive.[citation needed]
Intravenously administeredpenicillin is the treatment of choice. Associated pain can be treated withopiates,valproate, orcarbamazepine. Those with tabes dorsalis may also requirephysical therapy andoccupational therapy to deal with muscle wasting and weakness. Preventive treatment for those who come into sexual contact with an individual with syphilis is important.[citation needed]
Left untreated, tabes dorsalis can lead toparalysis,dementia, andblindness. Existing nerve damage cannot be reversed.[citation needed]
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-associatedHIV infection.[citation needed]
Although there were earlier clinical accounts of this disease, and descriptions and illustrations of the posterior columns of the spinal cord, it was the Berlin neurologistRomberg whose account became the classical textbook description, first published in German[4] and later translated into English.[5]
Sir Arthur Conan Doyle, author of theSherlock Holmes stories, completed hisdoctorate on tabes dorsalis in 1885.[6]