The onset of symptoms attributed to tabes dorsalis may occur anywhere from 3 to 20 years following syphilis infection [1]. The most common presentation consists of loss of coordination (sensory ataxia) and sudden sharp, stabbing-like (lancinating) pain in the face, back, or lower extremities. Other symptoms include loss of pain and vibration sensations (paresthesia), seizures (status epilepticus), visceral crisis characterized by repeated attacks of severe epigastric pain, nausea, and vomiting, loss of sexual function, and bladder dysfunction (i.e., urinary retention and overflow incontinence) [2] [3] [4] [5] [6].

Depending on the duration or stage of tabes dorsalis, a patient may present with either preataxia, ataxia, or paralysis [1]. Patients with tabes dorsalis typically present with a slapping and/or wide-based gait during ambulation [7].

• Falling

  He reports that the falls are most frequent when he is in a dark room. Medical history is significant for HIV infection, which is being managed with anti-retroviral therapy. [step1.medbullets.com]

  Falls das von Ihnen bestellte Buch besonders schwer oder sperrig sein sollte, werden wir Sie informieren, falls zusätzliche Versandkosten anfallen. [abebooks.fr]

  Follow up at 4 and 8 months demonstrated marked clinical improvement with a falling serum VRDL titre. Repeat LP at 6 month post treatment demonstrated VDRL negativity. Discussion Tabes Dorsalis may still occur in the post antibiotic era. [jnnp.bmj.com]

  Case Report A 78-year-old man was injured in a fall while wheeling his bicycle on a snowy road. [esciencecentral.org]

• Burning Pain

  Symptoms: Symptoms may not appear for some decades after the initial infection and include: weakness, diminished reflexes, paresthesias (shooting and burning pains, pricking sensations, and formication), hypoesthesias (abnormally diminished cutaneous, [medical-institution.com]

  Clinical Features: Weakness Diminished reflexes Paresthesias (shooting and burning pains, pricking sensations) Hypoesthesias (abnormally diminished cutaneous, especially tactile) Progressive degeneration of the joints Loss of coordination Personality [de.slideshare.net]

  Results of Tabes Dorsalis • Weakness • Paresthesias (shooting and burning pains, pricking sensations and formication) • Hyposthesias (abnormally diminished cutaneous, especially tactile, sensory modalities) • Loss of coordination • Dementia • Deafness [slideshare.net]

  Signs and symptoms[edit] Signs and symptoms may not appear for decades after the initial infection and include weakness, diminished reflexes, paresthesias (shooting and burning pains, pricking sensations, and formication), hypoesthesias (abnormally diminished [en.wikipedia.org]

• Difficulty Walking

  Coordination difficulties contribute to problems walking. [checkorphan.org]

  The patient began to experience difficulty walking in the dark and urinary incontinence and sought other medical advice. [lksom.temple.edu]

  They may also experience loss of body balance and coordination (sensory ataxia) with difficulty walking. [statpearls.com]

• Impaired Balance

  Problem List: Impaired sensation Weakness Hypotonicity Impaired coordination Impaired gait Impaired balance 9. Goals for Physiotherapy: 1. Educate about sensory loss and educate on precautions to be taken 2. Strengthening of muscles 3. [de.slideshare.net]

• Abdominal Pain

  […] in the legs, paralysis of the leg muscles, acute abdominal pain, etc Etymology: New Latin, literally: tabes of the back; see tabes, dorsal ' tabes dorsalis ' also found in these entries: [wordreference.com]

  Muscular function impairment, abdominal pains, and severe gastrointestinal/excretory system crisis (sudden onset with rapid subsidence) are observed. [dovemed.com]

• Fecal Incontinence

  Spinal cord involvement may cause weakness and wasting of shoulder-girdle and arm muscles, slowly progressive leg weakness with urinary or fecal incontinence or both, and, rarely, sudden paralysis of the legs due to thrombosis of spinal arteries. [msdmanuals.com]

• Hearing Impairment

  Other symptoms that may occur include seizures, stroke, behavioral changes, headache, dizziness, and hearing impairment. 7 Typical neurological findings include loss of vibratory, position and proprioceptive sense, and Argyll–Robertson pupil. [ncbi.nlm.nih.gov]

• Pupillary Abnormality

  Pupillary abnormalities are present in almost all the cases. Pupils on two sides are unequal. Accomodation reflex is retained while light reflex is lost. Complete Argyll-Robertson pupil may develop later on. [healthdrip.com]

  The mydriatic reaction to atropine is rather poor, and the pupil does not dilate with painful skin stimuli. [13] It must be realized, however, that pupillary abnormalities are not always of this typical pattern. [ijstd.org]

  An ophthalmological consult is recommended with pupillary abnormalities when considering the diagnosis of tabes dorsalis. [statpearls.com]

  Tremors of the mouth, tongue, outstretched hands, and whole body may occur; other signs include pupillary abnormalities, dysarthria, hyperreflexia, and, in some patients, extensor plantar responses. Handwriting is usually shaky and illegible. [msdmanuals.com]

• Miosis

  (La tabe dorsale è una mielo-meningoradicolite che interessa i cordoni posteriori del midollo spinale, con disturbi della sensibilità, atassia, assenza di riflessi, crisi dolorose, disturbi sfinterici, atrofia ottica e miosi.) [abebooks.com]

• Foot Ulcer

  Victims become unable to sense pain, limb position, and temperature; these sensory deficits cause loss of bladder and sometimes bowel control, severe foot ulcerations, and Charcot joints (an osteoarthritis that typically involves the knees and hip). [britannica.com]

  Common symptoms can include: Episodes of intense pain and disturbed sensation Weakness Diminished reflexes Unsteady gait Foot slap Progressive degeneration of the joints (Charcot's joints) Foot ulcers Loss of coordination Personality changes Dementia [syphilis.emedtv.com]

  Joint damage and foot ulcers occur and vision may be affected by optic nerve involvement. Treatment with penicillin can arrest the progress of the disease. Also known as locomotor ataxia. [medical-dictionary.thefreedictionary.com]

  Restoring pulsatile blood flow to the foot is one of the tenets of treatment of forefoot ulceration/gangrene. [woundsresearch.com]

• Formication

  Symptoms: Symptoms may not appear for some decades after the initial infection and include: weakness, diminished reflexes, paresthesias (shooting and burning pains, pricking sensations, and formication), hypoesthesias (abnormally diminished cutaneous, [medical-institution.com]

  Results of Tabes Dorsalis • Weakness • Paresthesias (shooting and burning pains, pricking sensations and formication) • Hyposthesias (abnormally diminished cutaneous, especially tactile, sensory modalities) • Loss of coordination • Dementia • Deafness [slideshare.net]

  Signs and symptoms[edit] Signs and symptoms may not appear for decades after the initial infection and include weakness, diminished reflexes, paresthesias (shooting and burning pains, pricking sensations, and formication), hypoesthesias (abnormally diminished [en.wikipedia.org]

• Back Pain

  A 28-year-old man was hospitalized with lightning back pain, nausea, and bladder bowel dysfunction. Serum and cerebrospinal fluid (CSF) revealed high titers of Treponema pallidum antibody, and the serum IgA level was less than 5 mg/dl. [ncbi.nlm.nih.gov]

  “Tabes dorsalgia” is a related back pain. “ Tabetic gait ” is a characteristic high-stepping gait of untreated syphilis where the patient’s feet slap the ground as they strike the floor due to loss of proprioception. [medical-institution.com]

  Now more commonly called “tabetic ocular crises,” an attack is characterized by sudden, intense ocular pain, lacrimation and photophobia. “Tabes dorsalgia” is a related back pain. [dailymeded.com]

  DTR are diminished or absent "Tabes dorsalgia" related back pain. "Tabetic gait" is a characteristic high- stepping gait - Tabetic Ataxia Deafness 6. [de.slideshare.net]

  Topic Snapshot A 44-year-old man presents with episodes of back pain and unintentional falls. The patient describes these pain episodes as a brief and stab-like sensation that lasts a few minutes. [step1.medbullets.com]

• Leg Pain

  The patient was treated with intravenous penicillin for 14 days, and gabapentin was started for the neuropathic leg pains. [nejm.org]

  This form of Neurosyphilis has becoming increasingly rare with the commencement of penicillin antibiotic treatment Optic Atrophy Tertiary Syphilis: Neurosyphilis – Tabes Dorsalis signs and symptoms include: Intense back and leg pain (stabbing pain that [dovemed.com]

• Neuropathic Arthropathy

  General Radiologically, it can manifest as a Charcot joint (neuropathic arthropathy), usually involving either the hip, knee or spine. MRI Longitudinal T2-weighted hyperintensity in the dorsal columns of the spinal cord. [radiopaedia.org]

  Arthropathy of the Glenohumeral Joint A Review of the Literature. 62 Santiesteban L...Zuckerman JD 29799367 2018 29 Tabes dorsalis: Not, at all, "Elementary my dear Watson!" [malacards.org]

  Total knee arthroplasty in neuropathic arthropathy. J Bone Joint Surg Br. 2002 Mar. 84(2):216-9. [Medline]. Marra CM, Maxwell CL, Tantalo LC, Sahi SK, Lukehart SA. [medscape.com]

  Salvage with arthrodesis in intractable diabetic neuropathic arthropathy of the foot and ankle. J Bone Joint Surg 1993;75A:1056-66. 36. Armstrong DG, Todd WF, Lavery LA, et al. [japi.org]

• Low Back Pain

  New Articles From the Editor Bouncing Back Resilience is the key to dealing with a neurologic condition. Disorders We've Got Your Back New ways of thinking about low back pain. [patients.aan.com]

• Ataxia

  (see also Paralysis) 344.9 Pel's crisis 094.0 Sclerosis, sclerotic posterior (spinal cord) (syphilitic) 094.0 Syphilis, syphilitic (acquired) 097.9 ataxia, locomotor (progressive) 094.0 cord, bladder 094.0 locomotor ataxia 094.0 spastic spinal paralysis [icd9data.com]

  Synonyms[edit] locomotor ataxia Translations[edit] degeneration Japanese: 脊髄癆 (せきずいろう, sekizuirō) [en.wiktionary.org]

  The most common presentation consists of loss of coordination (sensory ataxia) and sudden sharp, stabbing-like (lancinating) pain in the face, back, or lower extremities. [symptoma.com]

  — Ataxia, Locomotor — Ataxias, Locomotor — Locomotor Ataxias — Syphilitic Meningomyelitis — Meningomyelitides, Syphilitic — Meningomyelitis, Syphilitic — Syphilitic Meningomyelitides — Myelosyphilis — Spinal Cord Syphilis — Syphilis, Spinal Cord [mesh.kib.ki.se]

• Personality Change

  For clinical symptoms and signs, dementia and/or personality change were recorded in all patients with general paresis, and lancinating pain was found in six of seven cases of TD; another one case was recruited in this study because of visual loss. [neuro.psychiatryonline.org]

  changes; • Dementia; • Deafness; and • Visual impairment. [secure.ssa.gov]

  changes, dementia, deafness, visual impairment, and impaired response to light. [ninds.nih.gov]

  changes, urinary incontinence, dementia, deafness, visual impairment, positive Romberg’s test, and impaired response to light ( Argyll Robertson pupil ). [medical-institution.com]

• Abnormal Gait

  The condition tends to present 15 to 20 years after the initial infection and is characterized by lightening-like pains in the lower extremities, URINARY INCONTINENCE; ATAXIA; severely impaired position and vibratory sense, abnormal gait (see GAIT DISORDERS [finto.fi]

  The condition tends to present 15 to 20 years after the initial infection and is characterized by lightening-like pains in the lower extremities, Urinary incontinence ; Ataxia ; severely impaired position and vibratory sense, abnormal gait (see Gait disorders [jove.com]

• Hyporeflexia

  Physical findings: • Myelopathy with characteristic high stepping “tabetic gait;” • Loss of coordination and balance; • Pupils that react abnormally to light; • Diminished (hyporeflexia) or absent (areflexia) reflexes; • Episodes of intense pain and disturbed [secure.ssa.gov]

  Patients with tabes dorsalis commonly present with ataxia, Charcot joints, lancinating nerve pains, hyporeflexia, and Argyll-Robertson pupils. Key Points [pixorize.com]

  Ataxic gait and hyporeflexia are caused by purely sensory deficits due to irritation and destruction of the sensory afferents in the lumbosacral dorsal roots, affecting the incoming heavily myelinated proprioceptive fibers (later seen as demyelination [lksom.temple.edu]

  Charcot joint, hyporeflexia, Romberg sign, are also relatively common findings, as seen in this patient. Syphilitic optic atrophy 6 is considered a separate entity that is seen in less than 10% of cases. [ncbi.nlm.nih.gov]

• Confusion

  Classification of Syphilis Stage Description Symptoms and Signs Acquired Primary Contagious Chancre (a small, usually painless skin sore), regional lymphadenopathy Secondary Contagious Occurs weeks to months after the primary stage Rashes (which may be confused [merckmanuals.com]

  Even MRI enhancement may be confusing with that of tabes dorsalis. [statpearls.com]

  Presenile dementia is most common, manifesting with depression, confusion, and severe impairment of memory and judgment. [emedicine.com]

• Urinary Incontinence

  It is characterised by sensory ataxia, lightening pains and urinary incontinence. If left untreated it can progress to paralysis and dementia. [jnnp.bmj.com]

  Tabes dorsalis is a late manifestation of untreated syphilis that is characterized by ataxia, lancinating pains, and urinary incontinence. [ncbi.nlm.nih.gov]

  Clinical findings Sharp pain, ataxia, optic-nerve degeneration leading to blindness, urinary incontinence, loss of position sense, joint degeneration (aslo known as Charcot’s joints). tabes dorsalis Tabes syphilis, tabetic neurosyphilis Neurology Slowly [medical-dictionary.thefreedictionary.com]

  A 47-year-old man with a history of human immunodeficiency virus (HIV) infection presented with an 8-month history of severe paroxysmal shooting pains in his legs, progressive difficulty in walking, tinnitus, and urinary incontinence. [nejm.org]

• Overflow Incontinence

  Urine overflow incontinence is very common as the bladder loses its muscular tone. Constipation, impotence, deafness, painless foot ulcers and painless hip and knee arthritis are other features. [encyclopedia.com]

  Urinary retention and overflow incontinence may occur in the early stages due to bladder dysfunction. [statpearls.com]

• Dysuria

  A 22-year-old man with dysuria and numbness of the lower limbs; later found to be HIV-positive View Case Read more about 10172019 Comments [ajnr.org]

• Urinary Retention

  retention and overflow incontinence). [symptoma.com]

  Urinary retention and overflow incontinence may occur in the early stages due to bladder dysfunction. [statpearls.com]

Workup consists of a thorough history, physical exam, and laboratory testing (serum and cerebrospinal spinal fluid analysis). The medical history should elicit information about the current or past diagnosis of syphilis, neurologic or ocular disease, and human immunodeficiency virus infection.

A neurological and ocular physical exam should be performed. Abnormalities of the pupils are common in patients with tabes dorsalis; Argyll-Robertson pupils are present in approximately half of patients [8]. Other neurologic exam findings include loss of reflexes, proprioceptive sense, sensory ataxia, and/or Charcot joints [9]. Examination of the skin may reveal trophic ulcers (mal perforans).

Serum testing will establish the diagnosis of syphilis. Commonly used tests for syphilis include:

• Non-treponemal tests (venereal disease research laboratory -VDRL and rapid plasma reagin)
• Treponemal tests (Fluorescent treponemal antibody absorption, micro hemagglutination assay-T pallidum, fluorescent Treponemal antibody-absorption double staining)

During early syphilis, both types of test are positive. However, during late syphilis, such as with tabes dorsalis, non-treponemal tests may be negative and treponemal tests will be positive. This testing pattern indicates that the patient had syphilis in the past and may be at risk for neurosyphilis [10] [11].

A cerebrospinal fluid (CSF) exam should be performed to establish the diagnosis of neurosyphilis. Neurosyphilis is consistent with the following CSF findings: a negative CSF-VDRL, CSF lymphocyte count >5 cells/µL, and elevated protein count (>45 mg/dL) [12]. The CSF-VDRL test may be false positive when there is contamination of the CSF with blood [13] [14]. A polymerase chain reaction (PCR) for detection of treponemal nucleic acids may also be performed. The CSF may be tested for diagnostic markers of neurosyphilis such as intrathecally produced anti-treponemal antibodies and oligoclonal bands.

Tests that aid in the diagnosis, but are not confirmatory, include computed tomography (CT) and magnetic resonance imaging (MRI) of the brain and spine showing patterns of parenchymal disease that is consistent with neurosyphilis such as ischemic lesions, frontocortical atrophy, cerebral gumma, or disseminated frontal high signal lesions in T2-weighted MRI sequences [11] [15]. Electrophysiologic testing may prove useful for ruling out neurological disorders; a triad of normal nerve conduction studies that reveal absent H-reflexes, normal nerve studies, and reduced posterior column conduction is highly indicative of tabes dorsalis. An electroencephalogram (EEG) findings may indicate complex partial or isolated status epilepticus [4] [5].

• Cerebrospinal Fluid Abnormality

  Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis. 2004 Feb 1. 189(3):369-76. [Medline]. Holmes MD, Brant-Zawadzki MM, Simon RP. [medscape.com]

  fluid abnormalities in patients with syphilis: association with clinical and laboratory features. [statpearls.com]

  Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis. 2004 Feb 1. 189(3):369-76. [QxMD MEDLINE Link]. Holmes MD, Brant-Zawadzki MM, Simon RP. [emedicine.medscape.com]

Is there any treatment? Penicillin, administered intravenously, is the treatment of choice. Associated pain can be treated with opiates, valproate, or carbamazepine. [web.archive.org]

Treatment: Penicillin, administered intravenously, is the treatment of choice. Associated pain can be treated with opiates, valproate, or carbamazepine. Patients may also require physical therapy to deal with muscle wasting and weakness. [medical-institution.com]

Treatment does not reverse existing nerve damage. [pennstatehershey.adam.com]

Prognosis If left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness. Existing nerve damage cannot be reversed. x Prognosis If left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness. [ninds.nih.gov]

Prognosis If left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness. Existing nerve damage cannot be reversed. [brainfacts.org]

[edit | edit source] Prognosis is good after treatment, but Tabes dorsalis may lead to paralysis, blindness and dementia if left untreated. [physio-pedia.com]

[…] laboratory methods, more or less specific as indexes of syphilitic conditions, interest was renewed in the study of this disease entity, and I feel that it may be safely stated that it is now held that syphilis plays the all important rôle as the true etiologic [jamanetwork.com]

Regardless of etiology and pathogenesis, the diseases of the spinal cord mainly involving the dorsal column have similar manifestations. [statpearls.com]

Etiology Treponema bacteria (particularly during stages I /II) are highly contagious! Sexual contact with a partner who suffers from active syphilis will lead to infection in 30% of cases! [amboss.com]

"The Global Epidemiology of Syphilis in the Past Century - A Systematic Review Based on Antenatal Syphilis Prevalence". PLoS Negl Trop Dis. 10 (5): e0004711. doi : 10.1371/journal.pntd.0004711. PMC 4864207. [wikidoc.org]

Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Treponema bacteria (particularly during stages I /II) are highly contagious! [amboss.com]

[citation needed] Epidemiology[edit] The disease is more frequent in males than in females. Onset is commonly during mid-life. The incidence of tabes dorsalis is rising, in part due to co-associated HIV infection. [en.wikipedia.org]

Trials.gov US National Guidelines Clearinghouse NICE Guidance FDA on Tabes Dorsalis pathophysiology CDC on Tabes Dorsalis pathophysiology Tabes Dorsalis pathophysiology in the news Blogs on Tabes Dorsalis pathophysiology Directions to Hospitals Treating [wikidoc.org]

References: [3] [4] Pathophysiology Clinical features Primary syphilis Primary lesion ( chancre ) Typically starts out as a solitary, raised papule (usually on the genitals) Evolves into painle ss, firm ulcer with indurated borde rs and smooth base Resolves [amboss.com]

It was estimated that about 1.5% to 9% of syphilis is complicated by tabes dorsalis.[7] Pathophysiology Treponema pallidum pallidum invades the body through abrasions in the skin and intact mucous membranes and then travels via the lymphatics and blood [statpearls.com]

The understanding of the anatomy and the pathophysiology of the central nervous system was well advanced and contemporary descriptions of individual diseases of the nervous system are recognizable today. [karger.com]

Pathophysiology of Syphilis Syphilis is a sexually transmitted disease caused by Treponema pallidum. Human beings are the only host. [emedicine.com]

The NINDS supports and conducts research on neurodegenerative disorders, such as tabes dorsalis, in an effort to find ways to prevent, treat, and, ultimately, cure these disorders. [web.archive.org]

Treating the infection helps prevent new nerve damage and may reduce symptoms. Treatment does not reverse existing nerve damage. [healthing.ca]

Health knowledge - a thorough and concise knowledge of the prevention, causes, and treatments of disease, simplified for home use (1920) (14595212919).jpg 734 × 1 534; 110 KB The glands of life - a contribution to the study of organotherapy (1914) (14593762060 [commons.wikimedia.org]

Treating syphilis with antibiotics cures the infection and prevents new damage, but does not reverse the already present nerve degeneration and other complications. [secure.ssa.gov]

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