Syphilitic myelopathy Health Article

Definition

Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.

Alternative Names

Tabes dorsalis

Causes, incidence, and risk factors

Syphilitic myelopathy is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted, infectious disease. For information on the disease, see: Syphilis.

The condition called tabes dorsalis includes syphilitic myelopathy and additional symptoms of nerve damage.

The infection damages the tissue of the spinal cord and peripheral nervous tissue. This causes decreased muscle function (myelopathy), including progressive weakness of the legs, arms, and other areas. Loss of function may eventually result in paralysis.

Coordination difficulties contribute to problems walking. There are often changes in sensation, including painful paresthesia (abnormal sensations), which are also referred to as "lightning pains."

In syphilitic myelopathy, the muscle problems are accompanied by other symptoms characteristic of nervous system damage caused by syphilis. These include vision changes, stroke, and psychiatric illness.

Syphilitic myelopathy is now very rare because syphilis is usually treated early in the disease or as a result of screening blood tests that identify the disease in its latent (silent) form. Such blood tests are performed, for example, on individuals who donate blood and during pregnancy.

Symptoms

• Abnormal sensations, often called "lightning pains"
• Difficulty walking
• Loss of coordination
• Loss of reflexes
• Muscle weakness
• Wide-based gait (the person walks with the legs far apart)

Signs and tests

Physical examination may suggest myelopathy. Decreased or absent reflexes may be present due to nerve damage.

Tests may include the following:

• Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
• Serum VDRL or serum RPR (used as a screening test for syphilis infection -- if positive, one of the following will be required to confirm the diagnosis):
  • FTA-ABS
  • MHA-TP
• CSF (cerebrospinal fluid) examination
  • abnormal results indicating chronic meningitis
  • a positive neurosyphilis test (CSF VDRL test)