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Paretic neurosyphilis

This disease is sometimes referred to as dementia paralytica.   Typically, it occurs approximately 20-30 years after the initial exposure to Treponema pallidum.  It represents a chronic progressive frontotemporal meningoencephalitis with resultant ongoing loss of cortical function. Paretic neurosyphilis is caused by invasion of the brain by Treponema pallidum Cerebral atrophy most prominent in frontal lobes. is seen in General paresis. Microscopic Examination Inflammatory lesions are associated with parenchymal damage in the cerebral cortex (particularly the frontal lobe but also affecting other areas of the iso-cortex) characterized by: loss of neurons, Proliferations of microglia (rod cells), gliosis, and iron deposits. A. Chronic fibrotic lepto-meningitis over the frontal lobe (HE). B. Perivascular infiltration with lymphocytes and plasma cells in the subarachnoid space and parenchyma (Cresyl-violet). Hypertrophied, rod-shaped microglia in the cerebral cortex (Cresyl-violet and Hortega silver stain). Damage to the ependymal lining and proliferation of subependymal glia, called “granular ependymitis” in the ventricular wall (H&E). F. The spirochetes can, at times, be demonstrated in tissue sections (silver stain). Argyll-Robertson PupilsParetic neurosyphilisClinically manifested as insidious but progressive mental deficits Is a severe manifestation of neurosyphilis. It is a chronic dementia which ultimately result in death in 2 to 3 years. Patients generally have progressive personality changes Delusion of grandeur hallucinations Irritability, anger Inappropriate moods Low mood. Speach changes: decreased language ability (aphasia) Decreased motivation Impaired judgment Loss of ability to calculate Loss of long-term memory (long-past events) Loss of short-term memory (recent events) Muscle weakness (difficulty using legs, arms, or other parts of the body) Seizures Rarely, they have Psychosis, depression or mania.