Genitourinary crisis

Introduction One of the symptoms of spinal syphilis is a visceral crisis including a genitourinary tract crisis. Myelosyphilis is an important type of central nervous syphilis, including tabos dorsalis, spinal meningovascular syphilis, and syphilitic myelitis. Syphilitic myelitis often affects the meninges due to lesions, also known as syphilitic meningomyelitis. Syphilis is caused by a slender, spiral, active microbe, Treponema pallidum.

Cause

(1) Causes of the disease

Syphilis is caused by a slender, spiral, active microbe, Treponema pallidum. Treponema pallidum often enters the central nervous system 3 to 18 months after infection. If the cerebrospinal fluid examination is completely negative after 2 years of infection, the chance of developing central syphilis is 1/20; if the cerebrospinal fluid examination is completely negative after 5 years of infection, the chance of reduction is 1/100.

(two) pathogenesis

The central infection of syphilis begins with syphilitic meningitis (about 1/4 of total syphilis infection), a large part of which is asymptomatic meningitis, which can only be found through lumbar puncture, and a small part of it is cranial nerve palsy. More serious meningitis, such as epilepsy and elevated intracranial pressure. Syphilitic meningitis can eventually enter the brain or spinal cord during the period of asymptomatic period, including meningeal vascular syphilis, paralytic dementia, spinal cord hernia, syphilitic meningeal myelitis.

1. Spinal cord sputum: The posterior root of the spinal cord, especially the lumbosacral section, is obviously thinner and grayer. Due to the degeneration of the posterior column of the spinal cord, the spinal cord itself is also thinner. Only a few neurons in the dorsal root ganglia are seen, and the peripheral nerves are basically normal.

2. Syphilitic meningeal myelitis: the dural inflammatory hypertrophy, and adhesion to the arachnoid, pia mater, which in turn causes spinal cord supply of nerve and root damage, resulting in spinal cord degeneration, spinal cord long-chain damage signs.

3. Spinal cord vascular syphilis: subacute or acute transverse spinal cord injury, microscopically visible endovascular inflammation, perivascular inflammatory cell exudation and meningeal infiltration, spinal cord myelin and axon degeneration.

an examination

Related inspection

Complement-binding assay (Wassermann's complement-binding assay for intrauterine bacterial culture)

1. Spinal cord spasm: usually 15 to 20 years after syphilis infection, more common in men, the main symptoms are lightning-like pain, sensory ataxia and urinary incontinence, the main signs are knee reflexes and tendon reflexes, lower limb vibratory and The position is impaired and the closed eyes are difficult to be positive.

(1) Ocular manifestations: More than 90% of patients have pupillary abnormalities, usually manifested as A-Luo pupil, that is, the bilateral pupils are not large, narrow, and irregular, and the light reflection disappears, but the regulation of reflection exists. Most with cocoon and varying degrees of ophthalmoplegia, optic atrophy is also very common.

(2) Sensory disturbance: more than 90% of patients have lightning-like pain, which is more common in the lower extremities, but it can also be painful from the face to the lower limbs. The pain is sharp and short, and the nature is lightning-like, knife-cut, tear-like, burning. Wait, occasionally you can continue to have pain in one place. Ataxia is caused solely by deep sensory disturbances. When walking, the gait is squatting. It is a cross-threshold gait (the lower limbs are over-elevated while walking, and the stepping is more forceful, each step is different in size). Even in the late stage, even if the muscle strength is intact, it is difficult. walk.

(3) sphincter dysfunction: due to the posterior root lesion of the waist 2 to 4 segments, affecting the bladder sensation, although the bladder is full and no urine, forming urinary retention and filling urinary incontinence.

(4) visceral crisis: gastric crisis is the most common, manifested as sudden upper abdominal pain, and can extend to the chest, chest has a sense of contraction, may be associated with nausea, vomiting, vomiting often repeated to spit bile, after the attack, patients often Exhausted and feeling sore on the upper abdomen. Colic and diarrhea occur in the small intestine crisis; swallowing movements and dyspnea occur in the pharynx and throat crisis; urgency and weight in the rectal crisis; urination pain and difficulty in the genitourinary tract crisis. In addition to the stomach crisis, other crises are rare.

(5) Spinal ankle joint disease (Charcot arthritis): Charcot arthritis occurs in about 1/10 patients with spinal cord spasm, mainly involving the hip, knee and ankle joints. It can also affect the lumbar spine and upper limbs. It is initially osteoarthritis. Injury, joint surface destruction, loss of bone structural integrity, and fracture and dislocation. Charcot arthritis is not parallel to the activity of central syphilis.

(6) Most patients maintain good muscle strength.

2. syphilitic meningeal myelitis and meningeal vascular syphilis: often 3 to 5 years after the onset of syphilis infection. Syphilis meningitis due to its clinical manifestations of bilateral corticospinal tract damage, also known as Erb's spastic paraplegia (Erb's spastic paraplegia); part of the involvement of the meninges, often due to thickening of the meninges, adhesions, Compression of the nerve roots and spinal cord manifested as root pain in the neck, shoulders, upper limbs, muscle atrophy and sphilitic amyotrophy with spastic-ataxic paraparesis. The meningeal vascular syphilis of the spinal cord is mainly caused by vascular involvement. Spinal vascular thrombosis often occurs due to endarteritis, and the onset is rapid. The symptoms depend on the extent of the affected vessel. Occasionally, the anterior vertebral artery is caused by the anterior vertebral artery thrombosis. The sign can be kept intact.

According to the history of smelting, the history of syphilis infection, the manifestations of spinal cord injury, typical A-Luo pupil, serum and cerebrospinal fluid VDRL and FTA-ABS positive, the diagnosis is not difficult.

Differential diagnosis

Need to identify dysuria caused by other diseases:

Obstructive dysuria

(1) bladder neck lesions: the neck is blocked by stones, tumors, blood clots, foreign bodies, or uterine fibroids, ovarian cysts, late pregnancy compression; due to bladder neck inflammation, stenosis, etc. are all listed.

(2) posterior urethral disease: due to prostatic hypertrophy, prostate cancer, acute inflammation of the prostate, hemorrhage, empyema, fibrosis after compression of the urethra; posterior urethra itself inflammation, edema, stones, tumors, foreign bodies and so on.

(3) anterior urethral disease: seen in the anterior urethral stricture, stones, tumors, foreign bodies, or congenital malformations such as urethral valgus, penile foreskin incarceration, abnormal penile erection.

2. Functional dysuria

Found in spinal cord lesions, organic spine caused by recessive spina bifida; also seen in diabetic neurogenic bladder, caused by autonomic nerve damage caused by diabetes. Patients with neurosis can have difficulty urinating in public toilets. Surgical birth injury in the perineal area can cause urinary sphincter spasm caused by urinary dysfunction.

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