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Terms in this set (46)
Argyll Robertson pupils
Pupils constrict to focusing but do not constrict with direct light
Assesses peripheral nerve integrity
Evaluates various electrical mm properties
Useful for primarily evaluating the peripheral nervous system
Electrical equivalent to a mono synaptic stretch reflex
What kind of pathology does and H reflex indicate?
and/or Dorsal root ganglion
Person has eyes closed, feet together, and hands in outstreched position; person falling over in that position
Neurosyphilis infection by
Spirochete T. pallidum
Risk factors for syphilis
Syphilis is a risk factor for acquiring?
Patients with HIV and syphilis are at greater risk for what?
Developing neurosyphilis earlier
What is the gender distribution for neurosyphilis?
2x more common in men than women
How is T. pallidum first detected?
3 weeks after infection
There is a primary lesion on skin or mucous membrane
Secondary syphilis characterized by?
second bacteremic stage
generalized mucocutaneous lesion
What is tertiary syphilis?
When can T pallidum enter the CNS?
At the same time patients develop first and secondary syphilis
What are pathogenic changes that occur in syphilis?
-Endarteritis of terminal arterioles-->inflammatory and necrotic changes
Effects of syphilis in CNS?
-Arteritis of small and medium sized vessels
-Direct neuron damage
Clinical features of neurosyphilis depends on?
Time period after infection
Sensory impairment (48%)
Pupillary changes, Argyll Robertson Pupil (43%)
Positive romberg (24%)
What is pathognomonic for neurosyphilis?
Argyll Robertson Pupil
Tabes dorsales is infection of what?
T. pallidum infecting the spinal cord
What does infection at the spinal cord by T. pallidum cause?
Intermittent arm and leg pain
Ataxia and gait disturbance (loss of position sense)
Impaired vibratory and position sense
Based on clinical grounds
What confirms diagnosis?
CSF serology (RPR or VDRL)
protein and cell count abnormal
What are the different types of syphilis?
DDx for gummatous syphilis?
Space occupying lesions
-metastatic brain tumors
-primary brain tumors
DDx for meningovascular syphilis?
DDx for tabes dorsalis?
B12 deficiency-->subacute combined deficiency
Diffuse metastatic disease
What other diseases can an Argyll Robertson pupil be seen in?
How quickly does Tabes Dorsalis progress?
Slow and progressive
What does tabes dorsalis cause?
Demylination of posterior columns
Inflammatory changes in posterior roots of spinal cord
What do nerve conduction studies show in tabes dorsalis?
Impaired sensory nerve conduction studies
Normal motor nerve conductions
What studies are normal or abnormal?
-Absent H reflexes (dorsal root ganglion damage)
Tx of Tabes dorsalis?
High dose IV aqueous penicillin G
-->2-4 million units every 4 hours for 10 to 14 days
Tx of tabes dorsalis if penicillin allergy?
200 mg of Doxycycline 2x/day, for 28 days
Ceftriaxone 2g IV/day, 14 days
What if treatment does not work?
What should CSF show with treatment?
Drop in WBC count
Drop in protein
1-2 years after infection
Focal Hemispheric signs
Cerebrovascular and meningovascular disease
5-7 years after infection
Ischemia along MCA territory
10 years after infection
Impairment of higher cortical functions
Pyramidal tract dysfunction
Features suggesting psychiatric illness
Cranial nerve abnormalities
Any time after infection
Features directly related to gumma location which cause compression
Any time after infection
Absence of symptoms despite normal CSF findings seen with neurosyphilis
What are the 4 different forms of neurosyphilis?
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