Syphilitic myelopathy

• Alternative Names

  Tabes dorsalis

• Causes, incidence, and risk factors

  Syphilitic myelopathy is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted, infectious disease. For information on the disease, see: Syphilis.

  The condition called tabes dorsalis includes syphilitic myelopathy and additional symptoms of nerve damage.

  The infection damages the tissue of the spinal cord and peripheral nervous tissue. This causes decreased muscle function (myelopathy), including progressive weakness of the legs, arms, and other areas. Loss of function may eventually result in paralysis.

  Coordination difficulties contribute to problems walking. There are often changes in sensation, including painful paresthesia (abnormal sensations), which are also referred to as "lightning pains."

  In syphilitic myelopathy, the muscle problems are accompanied by other symptoms characteristic of nervous system damage caused by syphilis. These include vision changes, stroke, and psychiatric illness.

  Syphilitic myelopathy is now very rare because syphilis is usually treated early in the disease or as a result of screening blood tests that identify the disease in its latent (silent) form. Such blood tests are performed, for example, on individuals who donate blood and during pregnancy.

• Symptoms
  • Abnormal sensations, often called "lightning pains"
  • Difficulty walking
  • Loss of coordination
  • Loss of reflexes
  • Muscle weakness
  • Wide-based gait (the person walks with the legs far apart)
• Signs and tests

  Physical examination may suggest myelopathy. Decreased or absent reflexes may be present due to nerve damage.

  Tests may include the following:

  • Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
  • Serum VDRL or serum RPR (used as a screening test for syphilis infection -- if positive, one of the following will be required to confirm the diagnosis):
    • FTA-ABS
    • MHA-TP
  • CSF (cerebrospinal fluid) examination
    • abnormal results indicating chronic meningitis
    • a positive neurosyphilis test (CSF VDRL test)
• Treatment

  The goals of treatment are to cure the infection and to reduce progression of the disorder. Treatment of the infection reduces new nerve damage and may reduce symptoms but does not cure existing nerve damage.

  For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may undergo desensitization to penicillin so that they can be safely treated with it.

  Treatment of symptoms is required for existing neurologic damage. Assistance or supervision may be needed if the person is unable to perform self-care activities (eating, dressing, etc.). Rehabilitation, physical therapy, occupational therapy, or other interventions may be appropriate for people with muscle weakness.

  Analgesics may be required to control pain. These may include over-the-counter medications such as aspirin (oral salicylates) or acetaminophen for mild pain but narcotics may be required. Anti-epilepsy drugs such as carbamazepine may have a role in the treatment of lightning pains.

• Expectations (prognosis)

  Progressive disability is possible if the disorder is left untreated.

• Complications
  • Complications of late-stage syphilis infection, which may include:
    • Inflammation of the aorta (aortitis) with aortic aneurysm
    • Disease of the heart valves
    • Destructive changes in bones, skin, and other organs
  • Complications of neurosyphilis, including dementia, strokes, eye disease
  • Difficulty with walking and balance
• Calling your health care provider

  Call your health care provider if loss of coordination, loss of muscle strength, or loss of sensation occurs.

• Prevention

  Adequate treatment and follow-up of primary syphilis infections reduces the risk of developing syphilitic myelopathy.

  If you are sexually active, practice safe sex and always use a condom.

  All pregnant women should be screen for syphilis.

• References

  Centers for Disease Control and Prevention (CDC). Recommendations and Reports: Sexually Transmitted Diseases. MMWR Morb Mortal Wkly Rep. 2006;55(RR-11).

  U.S. Preventive Services Task Force. Screening for Syphilis Infection: Recommendation Statement. Ann Fam Med. 2004;2:362-365.

  Hook EW III. Syphilis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 340.

  Tremont EC. Treponema pallidum (Syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 235.

Review Date: 8/1/2008

Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Maternal & Child Health Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.