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Title: Cerebral syphilis : a clinical analysis of twenty-six cases, seven with autopsy
Author: Henderson, David Kennedy
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1913
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1. This thesis consists of the systematic clinical analysis of twenty-six personally observed cases of cerebral syphilis in seven of which the diagnosis was confirmed by autopsy. 2. Cerebral syphilis plays an important part in the production of mental disease, and should occupy a. more prominent place among the organic psychoses than it heretofore has done. 3. The spirochaeta pallida has for long been surmised to be the causal organism, but it was not until 1910 that Strasmann first demonstrated its presence in the central nervous system of an adult with acquired syphilis; the second case is reported in this thesis. Trauma, alcoholism, and physical and mental strain are important contributory factors. Reinfection with syphilis is quite possible provided the initial infection has been thoroughly cured. 4. Anatomically three main types of cerebral syphilis are differentiated, viz: meningitis, endarteritis, and gumma; clinically this differentiation is seldom possible, and is without practical value as the treatment is the same in all irrespective of the type. 5. The majority of cases of cerebral syphilis develop within the first three years after primary infection, and rarely more than ten years after infection; this is in striking contrast to cases of general paralysis and locomotor ataxia which almost invariably develop at a period more than ten years after infection. 6. In regard to the physical signs the Argyll Robertson phenomenon is the one on which most weight should be laid in differential diagnosis as it is rarely present in cases of cerebral syphilis. Other.important features are (a) an acute onset with headache, dizziness, and vomiting (b) cranial nerve palsies (c) convulsions without loss of consciousness but usually followed by permanent focal symp¬ toms (d) intactness of speech and writing (e) absence of facial tremor. 7. The mental symptoms of cerebral syphilis are of the nature of those seen in acute organic reactions and consist of confusion, delirium, amnesia, hallucinations, retention defect, and a poor memory for recent events; in addition there is relatively little disintegration of the personality. 8. The Wasserraann reaction must be considered in relation with the clinical picture in each individual case; when the Wassermann reaction with the cerebro-spinal fluid is negative the diagnosis of cerebral syphilis is indicated. 9. It is frankly admitted that there is no pathognomonic sign for cerebral syphilis, but if the nature and character of the onset, and the above mentioned physical and mental symptoms and signs are correlated, a disease entity is formed which has every right to be considered characteristic 10. Cerebral syphilis not infrequently causes pseudo-bulbar paralysis, and six cases of this affection have been here reported. 11. Anomalous features, among which may be mentioned euphoria and grandiose ideas, and confabulatory states, are more common in cerebral syphilis than in generally recognised; special attention must be paid to the setting in which these features occur because when occurring in a setting of confusion they mean practically nothing. 12. Recent statistics confirm one in the opinion that the prognosis of cerebral syphilis as compared with other organic affections of the nervous system is relatively good; the most favorable eases are those which develop soon after the primary infection, and those of a meningitic or gummatous type. 13. Mercury, no matter in what form administered, is an exceedingly valuable drug in the treatment of syphilis provided that it is given in a systematic way, The best results are, however, probably obtained by combining mercurial and salvursan treatment. Potassium iodide acts simply as an eliminative agent and has no specific action on the spirochaeta pallida. The only safe treatment is prophylaxis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available