One of the forms of syphilis of the brain is characterized by the occurrence of meningoencephalitis (damage to syphilitic treponema tissue of the brain and its membranes). Only 1-5% of syphilis survivors develop progressive paralysis. Men suffer 3-5 times more often than women. The average age of patients is from 35 to 50 years, i.e. progressive paralysis develops 10-15 years after the onset of syphilis. For the majority of those admitted for treatment in a psychiatric hospital for progressive paralysis, the syphilitic nature of the disease is established either directly during the examination, or by accident during hospitalization in other medical institutions, where a blood test for Wasserman's reaction is necessarily done. If a positive result is found, the patient is consulted by a venereologist, who, in turn, having determined the stage of the disease and mainly mental disorders, sends him to a psychiatrist. In other cases, the patient goes to the psychiatrist due to abnormal behavior or other mental disorders that others notice (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, because either they really did not 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 go through the full course of treatment.
Symptoms and course:At the initial stage of the disease, non-specific complaints of headaches, fatigue, irritability, sleep disturbances, lethargy appear. However, pretty soon there are signs of a decline in personality with the loss of skills, moral principles, and intellectual level. They cannot concentrate, they become oblivious, incapable of performing their usual functions (for example, for work). Not only is the consciousness of the disease lost, but unjustified optimism, increased mood, rudeness, explosiveness, disinhibition of drives appear. In other patients, on the contrary, dullness, 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. Either a complacent high spirits or a dull indifference prevails. The memory worsens sharply, dementia grows.
The initial stage (senility) occurs on average after 3-5 years from the onset of the disease. By this time, there is a complete breakdown of mental activity, physical helplessness leading to death is developing. 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, progressive paralysis is characterized by neurological manifestations: narrowing of the pupils, their irregularity (anisocoria) and irregular shape, lack of reaction of the pupils to light. One of the earliest symptoms is speech impairment (slurred speech), then epileptic seizures appear, handwriting changes, tendon reflexes are disturbed.
When making a diagnosis, special reactions of blood and cerebrospinal fluid to syphilis are also used. The most famous of them is the Wasserman reaction (R.V.).
The treatment of progressive paralysis consists in carrying out specific antibiotic therapy (8 courses) in combination with bioquinol. In the past, the method of vaccinating three-day malaria was widely used to increase body temperature, contributing to the death of pale treponema (the causative agent of syphilis). Currently, sulfosine, pyrogenal are used for this. The results of treatment are different, depending on the stage of the disease (the sooner the patient turns, the better the prognosis), as well as on the adequacy of therapy.
Prevention: prevention of syphilis in general and the full course of treatment in the early stages of the disease.