Neurolues

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Classification according to ICD-10
A52.1 Florid neurosyphilis
A52.2 Asymptomatic neurosyphilis
A52.3 Neurosyphilis, unspecified
ICD-10 online (WHO version 2019)

As neurosyphilis or neurosyphilis a number of characteristic is psychiatric or neurological symptoms referred to in untreated or not healed syphilis can the people with a latency period of years or decades occurring disease infection. In the late stage of neurosyphilis 2-5% suffer the syphilis luxation in a progressive paralysis (progressive paralysis), and men are affected more often than women. The progressive paralysis is usually associated with a tabes dorsalis (failure of functions of the spinal cord ). The examination of the cerebrospinal fluid ( liquor diagnosis) is important for the diagnosis of neurolues .

overview

Neurolues is not an independent disease, but a possible manifestation of the so-called tertiary stage (stage III, also referred to as "late stage") of syphilis (syphilis). In the more recent literature it is also referred to as an independent stage IV.

With neurolues, there is a progressive breakdown of nerve tissue ( degeneration , atrophy ) in the brain or spinal cord . Possible consequences of tissue destruction in the brain are changes in personality through to dementia , delusions (classic: " megalomania ", i.e. ideas of size), sometimes raptus- like seizures and often hallucinations . Syphilitic damage to the spinal cord often causes gait disorders ( ataxia ) and shooting (so-called lancinating) pain.

Neurolues has become rare in the western industrialized nations since the advent of effective antibiotics , as most syphilis diseases are cured at an earlier stage. This stage is more common in developing and emerging countries with inadequate health care.

The syphilis disease itself, as the cause of the neurolues symptoms, can be healed even in this late stage. However, limiting factors for the success of such a therapy are the blood-brain barrier , which is only sufficiently penetrated by a few antibiotics, and the fact that nerve tissue that has already disappeared can no longer be replaced by the human organism .

Epidemiology

Neurosyphilis was a very common complication of syphilis before antibiotic therapy was introduced. About 25 to 30 percent of patients with syphilis developed neurosyphilis. Of these patients, about a third each had asymptomatic neurosyphilis or tabes dorsalis and about 10 percent each had progressive paralysis or cerebrospinal syphilis . The rest was split into rarer forms of neurosyphilis.

diagnosis

In neurosyphilis, in addition to lymphocytic pleocytosis , IgG antibodies are also found in the nerve water .

Progressive paralysis

The progressive paralysis (progressive paralysis, popularly "softening of the brain") has become rare due to the good treatment options for syphilis nowadays . It is characterized by progressive dementia . Psychotic symptoms such as delusions , especially megalomania and personality disorders, are typical . An important physical symptom is the Argyll-Robertson's sign , which is a reflex pupillary rigidity with an often excessive convergence reaction. In the final stages of progressive paralysis, the patient becomes a nursing case .

Progressive Paralysis in the History of Neurology

Syphilis was a disease known since the Middle Ages. Looking back, several descriptions show that progressive paralysis as a brain disease became more common towards the end of the 18th century. At the beginning of the 19th century up to 10%, towards the end of the 19th century even about 20% and more of the prison inmates are said to have suffered from it.

The symptoms of progressive paralysis were described by the French doctor Antoine Laurent Bayle in 1822 and were associated with specific changes in the brain. The syphilitic cause of progressive paralysis was recognized in 1857 by Friedrich von Esmarch and Peter Willers Jessen . The pathogen, the Treponema pallidum , was not identified until 1905 by the zoologist Fritz Schaudinn . August Paul von Wassermann invented serodiagnostics in 1906. In 1913 the Japanese Hideyo Noguchi succeeded in detecting treponemas in the brains of paralysis patients. Alois Alzheimer and Franz Nissl carried out more detailed morphological investigations . Julius Wagner von Jauregg developed his first treatment in Vienna with malaria therapy , for which he received the Nobel Prize in 1927 . This was based on the clinical observation that the disease with another infectious disease improved the symptoms of a syphilitic person. So Wagner von Jauregg looked for a controllable infectious disease and found it in the malaria vaccination. From the 1940s on, syphilis was treated with antibiotics. This made it possible to prevent progressive paralysis.

The discoveries of progressive paralysis were fundamental in the history of psychiatry. This was the first time that a mental illness was attributed to somatic causes. This raised hope that brain research could generally explain mental illnesses somatically. Although this hope was not fulfilled, progressive paralysis remained "the model of physically justifiable psychoses in the sense of the exogenous reaction types according to Bonhoeffer ."

Tabes dorsalis

In the further course of the disease, the posterior cords of the spinal cord may become demyed ; this is known as tabes dorsalis (formerly also known as spinal cord consumption ; Latin tabes = "putrefaction, putrefaction").

therapy

Penicillins , especially benzylpenicillin , are still the first choice, although the success of the therapy must be serologically clarified quarterly using a VDRL test .

Others

The French writer Alphonse Daudet (1840–1897) saw the first signs of a spinal cord disease in 1884. He suffered increasingly from tabes dorsalis, the late effects of a syphilis infection. The last years of his life were strongly marked by the disease progressing to complete paralysis . It was during this time that his most poignant work was written, published in 1930 under the Provencal title La Doulou , In the Land of Sorrows . In this collection of notes, Daudet examines his illness and the associated changes in his person and environment with a relentless look. "In my [...] skeleton the pain echoes like the voice in an apartment without furniture or curtains."

Trivia

In the 1930s, a satirized stanza by Joseph Victor von Scheffel from the Trumpeter von Säckingen was rumored among the students of the University Medical Center Hamburg-Eppendorf :

This is ugly in life,
that the tabes are right at the syphilis. We have already been told
by Romberg
that people then go atactic.
I read it in your eyes,
on the pupil of rigid blue.
God protect you, it would have been so nice.
God protect you, your back leg is turning gray.

literature

Remarks

  1. ↑ H. Houston Merritt, Raymond D. Adams, Harry C. Solomon: Neurosyphilis. Oxford University Press, New York NY 1946.
  2. ↑ Cf. for example A. Müller, RW Schlecht, Alexander Früh, H. Still The way to health: a faithful and indispensable guide for the healthy and the sick. 2 volumes, (1901; 3rd edition 1906, 9th edition 1921) 31st to 44th edition. CA Weller, Berlin 1929 to 1931, Volume 2 (1929), pp. 115-119: The paralysis of the mad (brain softening or megalomania) .
  3. ↑ See also L. v. Angyal, K. Gyarfas: The prognosis of the schizophrenic form of progressive paralysis. In: Zschr. Ges. Neurol. Psychiatr. Volume 153, 1935, pp. 753-769, doi : 10.1007 / BF02865777 .
  4. ↑ Heinz Schott, Rainer Tölle: History of Psychiatry. Disease teachings, wrong turns, forms of treatment. Beck, Munich 2006, ISBN 3-406-53555-0 , pp. 80-81.
  5. ↑ Heinz Schott, Rainer Tölle: History of Psychiatry. Disease teachings, wrong turns, forms of treatment. Beck, Munich 2006, ISBN 3-406-53555-0 , p. 81.
  6. ↑ Alphonse Daudet : Master narratives . 7th edition. Manesse-Verlag, Zurich 1997, ISBN 3-7175-1088-6 , p. 313 .