Tabes dorsalis (patient information)
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Tabes dorsalis |
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Tabes dorsalis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]Varun Kumar, M.B.B.S.
Overview
Tabes dorsalis includes syphilitic myelopathy and other symptoms of nerve damage. Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.
What are the symptoms of Tabes dorsalis?
- Lightning pains[1]
- Impaired sensation and proprioception[2]
- Hypesthesias[3]
- Progressive sensory ataxia(inability to feel the lower limbs)[4]
- Diminished reflexes or loss of reflexes[5]
- Poor coordination or loss of coordination[6]
- Unsteady gait(locomotor ataxia)[7]
- Sexual function problems[8]
In Tabes dorsalis, there are also symptoms of nervous system damage, including:
- Mental illness
- Stroke
- Vision changes
What causes Tabes dorsalis?
Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue.[9]
When to seek urgent medical care?
Call your health care provider if you have:
- Loss of coordination
- Loss of muscle strength
- Loss of sensation
Diagnosis
Physical examination may show:
- Positive romberg test is one of the most important findings in physical examination of patients with tabes dorsalis[9]
- Patient is usually oriented to persons, place, and time
- Hyporeflexia or areflexia may be seen[3]
- Impaired balance bilateral Babinski's Reflex may be present[8]
- Bilateral muscle weakness mostly in lower limbs may be seen[10]
- Argyll Robertson pupils may be present[11]
- Bilateral sensory loss in the extremity mostly in lower limbs may be seen[12]
- Broad base gate and Sensory ataxic gait is usually seen in patients with tabes dorsalis[12]
- Cranial nerve palsy caused by gummatous neurosyphilis may be seen[13]
- Finger-to-nose test is usually abnormal[14]
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
Treatment options
The goals of treatment are to cure the infection and slow the progression of the disorder. Treating the infection helps prevent new nerve damage and may reduce symptoms, but it does not reverse existing nerve damage.
For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may have to be desensitized to penicillin so that they can be safely treated with it.
Symptoms of existing neurologic damage need to be treated. People who are unable to eat, dress themselves, or take care of themselves may need help. Rehabilitation, physical therapy, and occupational therapy may help people who have muscle weakness.
You may needanalgesics to control pain. These may include over-the-counter medications such as aspirin or acetaminophen for mild pain, or narcotics for more severe pain. Anti-epilepsy drugs such as carbamazepine may help treat lightning pains.
Where to find medical care for Tabes dorsalis?
Directions to Hospitals Treating Tabes dorsalis
What to expect (Outlook/Prognosis)?
Progressive disability is possible if the disorder is left untreated.
Possible complications
- Complications of late-stage syphilis infection, which may include:
- Inflammation of the aorta (aortitis) with aortic aneurysm
- Disease of the heart valves
- Damage to bones, skin, and other organs
- Complications of neurosyphilis, including dementia, stroke, eye disease
- Difficulty with walking and balance
- Paralysis
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000729.htm
- ↑ MAO S, LIU Z (2009). "Neurosyphilis manifesting as lightning pain". Eur J Dermatol. 19 (5): 504–6. doi:10.1684/ejd.2009.0712. PMID 19487174.
- ↑ Vora SK, Lyons RW (2004). "The medical Kipling--syphilis, tabes dorsalis, and Romberg's test". Emerg Infect Dis. 10 (6): 1160–2. doi:10.3201/eid1006.031117. PMC 3323152. PMID 15224672.
- ↑ 3.0 3.1 Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
- ↑ Sabre L, Braschinsky M, Taba P (2016). "Neurosyphilis as a great imitator: a case report". BMC Res Notes. 9: 372. doi:10.1186/s13104-016-2176-2. PMC 4964046. PMID 27465246.
- ↑ Smikle MF, James OB, Prabhakar P (1988). "Diagnosis of neurosyphilis: a critical assessment of current methods". South Med J. 81 (4): 452–4. PMID 3358168.
- ↑ Mehrabian S, Raycheva M, Traykova M, Stankova T, Penev L, Grigorova O; et al. (2012). "Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging". BMC Neurol. 12: 96. doi:10.1186/1471-2377-12-96. PMC 3517431. PMID 22994551.
- ↑ Gue JW, Wang SJ, Lin YY, Liao KK, Wong WW (1993). "Neurosyphilis presenting as tabes dorsalis in a HIV carrier". Zhonghua Yi Xue Za Zhi (Taipei). 51 (5): 389–91. PMID 8334567.
- ↑ 8.0 8.1 Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M (2009). "Case of neurosyphilis presented as recurrent stroke". Oman Med J. 24 (2): 134–6. doi:10.5001/omj.2009.29. PMC 3273935. PMID 22334859.
- ↑ 9.0 9.1 French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
- ↑ Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R (2006). "Neurosyphilis manifesting as spinal transverse myelitis". Medicina (Kaunas). 42 (5): 401–5. PMID 16778468.
- ↑ Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". J Neuroophthalmol. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
- ↑ 12.0 12.1 Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 160–3. PMC 2582679. PMID 19148316.
- ↑ Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J (1993). "Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings". AJNR Am J Neuroradiol. 14 (6): 1329–31. PMID 8279327.
- ↑ Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD (2009). "Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report". Cases J. 2: 8334. doi:10.4076/1757-1626-2-8334. PMC 2769430. PMID 19918420.