One of the forms of syphilis of the brain, characterized by the occurrence of meningoencephalitis (affection of the syphilitic treponema tissue of the brain and its membranes). Only 1-5% of those who have had syphilis develop progressive paralysis. Men suffer 3-5 times more often than women. The average age of patients from 35 to 50 years, i.e. Progressive paralysis develops 10–15 years after the onset of syphilis. For the majority of people admitted to a psychiatric hospital for treatment of progressive paralysis, the syphilitic nature of the disease is established either directly during the examination or by chance during hospitalization at other medical institutions, where a blood test is required for Wasserman's reaction. When a positive result is found, the patient is consulted by the venereologist, who, in turn, after determining the stage of the disease and mainly mental disorders, sends him to a psychiatrist. In other cases, the patient goes to a psychiatrist due to improper behavior or other mental disabilities that are noticed by others (the patient usually does not have a critical attitude to his illness), and the nature of the disease is established in the clinic. Patients, having learned their diagnosis, are often perplexed about this or even deny the presence of syphilis in the past, since they either did not really attach importance to the mild manifestations of the disease at stages 1 and 2 of the disease, or for one reason or another did not complete the full course of treatment.
Symptoms and course:At the initial stage of the disease, nonspecific complaints of headaches, fatigue, irritability, sleep disturbances, and lethargy appear. However, signs of decline in personality with the loss of skills, moral attitudes, and intellectual level soon appear. They cannot concentrate; they become forgetful and untenable in performing their usual functions (for example, at work). Consciousness of the disease is not only lost, but unjustified optimism, heightened mood, rudeness, explosiveness, disinhibition of desires appear. In other patients, on the contrary, stupidity, indifference, lethargy increases.
The middle stage of the disease (paralytic dementia) is characterized by the leveling of individual personality traits with a complete loss of criticism. Prevails either complacent high spirits, or stupid indifference. Memory deteriorates sharply, dementia increases.
The initial stage (marasmus) begins on average in 3-5 years from the onset of the disease. By this time there is a complete disintegration of mental activity, physical helplessness leading to death develops. However, with modern methods of treatment, patients usually do not reach this stage, but remain at the level of paralytic dementia.
Recognition:In addition to mental disorders for progressive paralysis, neurological manifestations are characteristic: constriction of the pupils, their irregularity (anisocoria) and irregular shape, lack of reaction of the pupils to light. One of the earliest symptoms is a speech disorder (slurred speech), then epileptic seizures appear, handwriting changes, tendon reflexes are disturbed.
When making a diagnosis, special reactions of the blood and cerebrospinal fluid to syphilis are used. The most famous of these is the Wasserman reaction (R.V.).
Treatment of progressive paralysis consists of specific antibiotic therapy (8 courses) in combination with biocinol. In the past, the three-day malaria vaccination method was widely used to increase body temperature, contributing to the death of pale treponema (the causative agent of syphilis). Currently, for this use sulfosin, pyrogenal. The results of treatment vary, depending on the stage of the disease (the earlier the patient is treated, the better the prognosis), as well as the adequacy of therapy.
Prevention: the prevention of syphilis in general and the full course of treatment in the early stages of the disease.