No abstract available.
Spine* ; Spondylitis, Ankylosing* ; Tabes Dorsalis*

Adult ; Disease Progression ; Humans ; Male ; Tabes Dorsalis

In 1868 Charcot described the joint in tabes dorsalis, which since then has been designated as Charcot neuroarthrophathy. It is characterized by painless swelling and abnormal mobility of the affected joint. Arthrophthy of the type described by Charcot has been associated with various other conditions, such as diabetes mellitus, syringomyelia, injury to nerve root, congenital indifference of pain, leprosy, and intra articular use of steroid, etc. Authors present a case of Charcot spine due to tabes dorsalis.
Diabetes Mellitus ; Joints ; Leprosy ; Spine ; Syringomyelia ; Tabes Dorsalis

In 1868 Charcot described the join in tabes dorsalis, which since then has been designated as Charcot neuroarthropathy. It is characterized by painless swelling and abnormal mobility of the affected joint. Arthropathy of the type described by Charcot has been associated with various other conditions, such as diabetes mellitus, syringomyelia, injury to nerve root, congenital indfference to pain, leprosy, and intra-articular use of steroid, etc. Authors present a case of Charcot joint which involved the left knee joint associated with pathologic fracture of the left tibia and fibula.
Arthropathy, Neurogenic ; Diabetes Mellitus ; Fibula ; Fractures, Spontaneous ; Joints ; Knee Joint ; Knee ; Leprosy ; Syringomyelia ; Tabes Dorsalis ; Tibia

85 cases of neurosyphilis were observed in Seoul National University Hospital over 6-year period (1979-1984). They were analyzed with respect to clinical symptoms and signs in individual types, serological data in both blood and CSF, changes of cytochemical compositions in CSF, and other significant findings. And some coparisons with other reports were made. They ranged from 22 to 66 years in age with the peak incidence in the forties (41%). Ratio of male to female was observed to be 4.3:1. There were 27 cases of asymptomatic neurosyphilis (NS) (32%), 14 cases of tabes dorsalis (16%), 18 cases of general paresis (21%), 2 cases of taboparesis (2%), 7cases of vascular NS (8%), 6 cases of meningeal NS (7%), 4 cases of syphilitic eight nerve involvement (5%), 4 cases of late syphilitic ocular involvement including optic atrophy (5%), and 3 cases of spinal form (4%). Except in 4 self-referral cases, alimentary system symptoms or illnesses were the main prolbems in asymptomatic neurosyphilitics (48%). Most symptomatic cases had the similar clinical pictures as described in the previous reports but some cases appeared to be combined with symptoms and signs of different types. In tabes dorsalis, patients presented paresthesia and hypoactive DTRs in lower limbs as the most frequent features. According to predominant manifestations, there were 4 cases of dementic form and 14 cases of psychotic form in general paresis but in most cases both features overlapped each other. In 8 cases of general paresis brain CT scans were performed, which revealed diffuse cerebral atrophy in five. Focal abnormalities of vascular NS were most frequently found in temporal areas (4 in 7 cases). Meningeal irritation signs were observed only in one among 6 cases 6 meningeal NS. All cases of eighth nerve involvement showed sensorineural hearing loss at high-tone level. Compared with TPHA, which was used as a criterion for the patient selection, VDRL reactivity was 98% in serum and 49% in CSF. It is notable that as for general paresis and meningeal NS, higher reactivity and elevated titers of CSF VDRL were associated with increase of cells and total protein in CSF, suggesting higher disease activity in both types. Unlike those from other countries, the domestic studies including this report show that general paresis occupies a relatively higher proportion than tabes dorsalis in Korea.
Atrophy ; Brain ; Digestive System ; Female ; Hearing Loss, Sensorineural ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Neurosyphilis* ; Optic Atrophy ; Paresthesia ; Patient Selection ; Seoul ; Tabes Dorsalis ; Tomography, X-Ray Computed

PURPOSE: Neuropathic arthropathy of the elbow is extremely rare and is characterized by painless destruction of the joint due to diminished proprioception. We report five cases of neuropathic arthropathy of the elbow with review of pertinent literature. MATERIALS AND METHODS: We analyzed records of five patients who were diagnosed with neuropathic arthropathy of the elbow. There were three men and two women with a mean age of 38.6 years (range, thirteen to fifty years). The conditions associated with the arthropathy were three cases of syringomyelia, one tabes dorsalis, and one neurofibromatosis. One patient was conservatively treated and was followed periodically and others underwent operative procedures. The mean duration of follow-up was 8.5 years (range, one to nineteen years). Changes of symptoms, range of motion (ROM), and functional satisfaction were assessed. RESULTS: The conservatively treated patient maintained the function of the elbow. In the surgically treated group, one case of ulnar nerve decompression and one case of osteosynthesis of the fractured olecranon showed improvement of symptoms, ROM, and function. But two patients who underwent reconstructive procedures had decreased ROM after complication of deep infection. Concluson: Neuropathic arthropathy of the elbow causes few functional problems despite of the radiologic destruction and instability of the elbow. Therefore symptomatic management is considered more preferable than surgical correction of destruction or instability of the elbow.
Decompression ; Elbow ; Female ; Follow-Up Studies ; Humans ; Joints ; Male ; Neurofibromatoses ; Olecranon Process ; Proprioception ; Range of Motion, Articular ; Surgical Procedures, Operative ; Syringomyelia ; Tabes Dorsalis ; Ulnar Nerve

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.
Brain ; Cerebral Arteries ; Cerebral Infarction* ; Constriction, Pathologic ; Cranial Nerve Diseases* ; Cranial Nerves ; Diagnosis ; HIV* ; Humans ; Magnetic Resonance Imaging* ; Meninges ; Meningitis ; Middle Aged ; Neurosyphilis* ; Posterior Cerebral Artery ; Spinal Cord ; Spine ; Spirochaetales ; Syphilis ; Tabes Dorsalis ; Treponema pallidum ; Vestibulocochlear Nerve

By doing MRI of spinal cord and elctrophysiological studies we were going to correlate MRI and electrophysiologi-cal findings with the known pathology of tabes dorsalis. A 45 year old male patient developed gait ataxia with a tin-gling sense in hands and feet in september of 1996. Neurological examination revealed impaired position sense in his great toes and thumbs with profound instability in the Romberg test, and areflexias in his knee and ankle jerks. Serum VDRL and TPHA test results were positive. CSF revealed pleocytosis(WBC : 16/cubic mm), elevated protein level, and reactive VDRL and FTA-ABS tests. Spinal MRI showed high signal intensity in the posterior part of the entire length of the cervical cord without enhancement with Gadolinium. Follow-up spinal MRI of the cervical area, which was taken two years after penicillin treatment did not show any interval change and spinal MRI of thoracolumbar area also showed similar finding to that of the cervical cord. Nerve conduction studies before and after the penicillin trea-ment showed normal findings except absent H-reflexes. However, the somatosensory evoked potentials with posterior tibial nerve stimulation did not show any abnormalities, which were incompatible with previous report and the known pathologic abnormality. Normal somatosensory evoked potentials suggests using any other pathways than the posterior column in conducting somatosensory evoked potentials.
Ankle ; Evoked Potentials, Somatosensory ; Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Foot ; Gadolinium ; Gait Ataxia ; H-Reflex ; Hand ; Humans ; Knee ; Magnetic Resonance Imaging* ; Male ; Middle Aged ; Neural Conduction ; Neurologic Examination ; Pathology ; Penicillins ; Proprioception ; Spinal Cord ; Tabes Dorsalis* ; Thumb ; Tibial Nerve ; Toes