MENINGOVASCULAR SYPHILIS

WHAT IS MENINGOVASCULAR SYPHILIS

Meningovascular Syphilis is the syphilis that effects the nervous system and it mainly occurs after the infaction of heart and vesssels.

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CAUSATION OF MENINGOVASCULAR SYPHILIS

It mainly occurs during the secondary stage of syphilis and the essential lesions of meningovascular syphilis are endarteritis obliterance and perivascular cuffing by lymphocytes.

CLINICAL FEATURES

1.Asymptomatic Neuro-syphilis

The only change observed is in CSF in the form of increased lymphocytes. Associated with this, there is positive CSF serology and slight increase of protein occasionally clinical signs are mainly absent in this case.

2.Acute Syphilitic Meningitis

Clinical features resemble ordinary meningitis but evidences of syphilis will be found in blood and CSF.

3.Cerebral Pachymeningitis

It is rare and characterised by thickening of the dura mater. Headache is the usual complaint.

4.Cerebral Lepto-meningitis

When the pathological changes are mostly located in the vertex, cortical irritation and atrophy develop. This results in headache, mental changes, jacksonian fits, aphasis and loss of sphincteric control. When the lesion is located in the basal part of the brain isolated or multiple cranial nerve palsies (particularly 2nd to 8th cranial nerve) are seen.

 5.Cerebral Endarteritis

This leads to cerebral thrombosis and ultimate development of cerebral infarction giving rise to hemiplegia or monoplegia according to the site of involvement. As atherosclerosis occurs in aged individuals cerebral thrombosis in young persons would always arouse suspicion of non atherosclerotic aetiology.

6.Cerebral Gumma

This is rare. It is manifested by all features of space occupying lesion. Signs and symptoms depend on the site of involvement and the rate of progress.

7.Pachymeningitis Hypertrophic Cervicalis

In the cervical region dural membrane becomes very much thickened as a result of gummatous involvement. Due to this, spinal cord is strangulated and as such anterior and posterior nerve roots are irritated giving rise to wasting and pain in the upper limbs. There may also be evidences of pyramidal lesion in the lower limbs due to compression of both pyramidal tracts in the region.

8.Chronic Meningomyelitis

The lesion is usually located in the dorsal region. Patient complains of girdle pain and gradually develops all features of progressive transverse myelitis.

9.Erb’s Syphilitic spinal Paralysis

In this rare condition slow progressive spastic paraplegia develops with loss of sphincter control but there is no sensory loss.

10.Spinal Endarteritis

Spinal endarteritis may affect anterior or posterior spinal artery and results in thrombosis of the affected vessel. When anterior spinal artery is affected there is infarction of the gray mater of the spinal cord and thus anterior horn cells of the spinal cord and spinothalmic tracts are affected. There will be evidences of lower motor neurone lesion at the level and loss of crude touch, pain and temperature sensation below the level of lesion. When posterior spinal arteries are affected posterior horns and white mater are affected. So, there will be evidences of loss of all sensations at the level and pyramidal lesion below the level of lesion. This is called acute transverse myelitis.

11.Syphilitic Amyotrophy

This is seen in lesion of the cervical region characterised by degeneration of anterior horn cells, muscular wasting in the upper limbs and shoulder girdle starting in the hand. The lower limbs are usually normal but sometimes there may be spastic paralysis. Pupillary abnormalities are absent and sphincter disturbances are rare.

12.Syphilitic Radiculitis

Dorsal roots are commonly affected characterised by pain and later on anesthesia. Ventral roots are rarely affected.