Impaired lower extremity vibration and position sense

Introduction One of the manifestations of spinal syphilis is the main signs of spinal cord spasm: knee reflexes and tendon reflexes, lower limb vibratory and positional impairment, and closed eyes are difficult to sign positive. 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.

Cause

Causes

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.

an examination

Related inspection

Blood test neurological examination

Spinal cord fistula

It usually occurs 15 to 20 years after syphilis infection. It is more common in men. The main symptoms are lightning-like pain, sensory ataxia and urinary incontinence. The main signs are knee reflex and tendon reflex, lower limb vibration and positional impairment. Closed eyes are difficult to sign 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.

Differential diagnosis

Need to be differentiated from other diseases, syphilis meningeal myelitis needs to be differentiated from motor neuron disease, cervical spondylosis, multiple sclerosis, spinal cord tumors; spinal cord hernia needs to be differentiated from diabetes, subacute combined degeneration, pseudo-thoracic spinal cord.

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.

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