是脊髓痨:区别en revisions

Introduction[edit|edit source]

Tabes dorsalis is a slowly progressive degenerative disorder of the dorsal column and dorsal root of thespinal cord. Tabes dorsalis is caused by demyelination as a result of an untreatedsyphilisinfection caused byTreponema pallidum.Treponema palliduminfection, if left untreated or partially treated, can lead to late neurosyphilis which has two forms, general paresis (also known as "syphilitic dementia," "dementia paralytica" or "paretic neurosyphilis") and tabes dorsalis (also known as "locomotor ataxia").^[1]Neurosyphilis may be a more common and more aggressive complication of syphilis in those infected withHIV.^[2]It is more common in males than in females.

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Clinically Relevant Anatomy
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Sensory information is transmitted through the dorsal (posterior) column of the spinal cord and through the medial lemniscus in the brainstem.The dorsal column-medial lemniscal pathwayis responsible for conveying sensations of vibration,proprioceptionand fine touch (tactile sensation).

Pathological Process[edit|edit source]

Treponemes are spirochetes, which are thin, delicate, helically coiled organisms measuring 5-20 µm in length.^[4]Treponema pallidumcan be transferred vertically from mother to fetus and through sexual intercourse.^[5]Tabes dorsalis is a parenchymatous form of neurosyphilis and typically has a latency of 15–30 years from the time of infection.^[6]The disease usually involves three phases. The primary infection follows the inoculation of an individual with about 500–1000 bacteria. Within 36 hours, these replicate and result in a painless ulceration called a chancre. These typically occur in the genital areas. After 2–6 weeks the second stage of the disease continues, with wide infiltration throughout the body and nervous system. Afterward, during the latent stage of disease, patients are frequently asymptomatic for many years. About 10% of patients with untreated syphilis develop neurological symptoms called neurosyphilis, or tabes dorsalis, 10–15 years later.^[7]

Clinical Presentation[edit|edit source]

The neurologic presentation is one of ongoing loss of pain sensation, loss of peripheralreflexes, impairment of vibration and position senses, and progressiveataxia.^[8]The earliest stages of neurosyphilis involve inflammation of the meninges presenting withheadache, nausea, vomiting, and, occasionally, seizures.^[7]There may be chronic destructive changes in the large joints of the affected limbs in far-advanced cases (i.e.,Charcot's joints).Urinary Incontinence膀胱和阳痿是常见的。突然一个d severely painful crises of uncertain origin are a characteristic part of the syndrome.^[9]

Diagnostic Procedure[edit|edit source]

Diagnosis of syphilis is made using two types of tests: (1) non-treponemal serum screening tests, such as the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) test; and (2) treponemal-specific tests such as the fluorescent treponemal antibody absorption test (FTA-ABS),T. pallidumparticle agglutination assay (TP-PA), and microhemagglutination test for antibodies toT. pallidum(MHA-TP).^[10]SinceTreponema pallidumcannot be grown in a culture medium, serology and CSF examination are the mainstays for diagnosis.^[1]In patients with suspectedneurosyphilisand stroke, a negative CSF FTA-ABS effectively rules out the disease and a positive VDRL effectively confirms it. In patients with a positive CSF FTA-ABS and a negative VDRL, CSF protein and cell count and clinical judgment might be needed to decide on the treatment.^[11]

Management / Interventions[edit|edit source]

Medical treatment[edit|edit source]

Medical treatment involves penicillin, administered intravenously. Opiates, valproate and carbamazepine are some of the analgesics used in treating pain associated with Tabes dorsalis.

Physiotherapy management[edit|edit source]

Physiotherapy management includesFrenkel's exercise, strengthening exercises, balance retraining and use of辅助设备. Aims of physiotherapy management include:

• Improvecoordination
• Improvemuscle strength.
• Improve muscle endurance.
• Improvebalance.
• Improveposture.
• Retrain normal movement pattern.
• Educate the patient about sensory loss and precautions to be taken.

Preventive management[edit|edit source]

Preventive drug therapy should be given to those who have sexual contact with an individual with syphilis.

Differential Diagnosis[edit|edit source]

The differential diagnostic possibilities ofneurosyphilisare broad, given the protean manifestations of its various forms and stages. Some of the conditions that present similar clinical features as Tabes dorsalis include:

• Vascular DiseaseMyelopathy
• Post infectious Demyelination
• Hereditary and Other Demyelinating Disorders
• Spinal Tumors Miscellaneous Spinal Cord Myelopathy
• Non-Syphilitic Argyll Robertson Pupil
• Acutemeningitis

Prognosis[edit|edit source]

Prognosis is good after treatment, but Tabes dorsalis may lead to paralysis, blindness anddementiaif left untreated.

References[edit|edit source]