Congenital neurosyphilis, Gunma slow virus infections of central nervous system

Stigma of occurring at birth include hydrocephalus, mental retardation, seizures, Chorioretinitis, atrophy optics and nerve deafness. These can be associated with other congenital syphilis evidence. Participation neurological develop later in congenital syphilis may take the form of injuries meningovascular, optic atrophy, tabes or GPI. The parenchymal lesions occur late at a much younger age (minor, GPI juvenile tabes).

Diagnosis: Neurosyphilis should be considered in the differential diagnosis of neurological disorders. GPI must differentiate disorders strokes, main dementias, space intra-beats injury and progressive degenerative lesions of occupation.Tabes should be considered in the differential diagnosis of lesions such as diabetic, toxic and nutritional neuropatheis heredofamilial, ataxia and siringomielia.Presencia Argyll Robertson pupil is a strength to support the diagnosis of neurosyphilis.

Diagnostic laboratory; Serology blood is positive in 60-70% of cases. Changes in the CSF are present in many.These include, Lymphocytic pleocytosis rises in proteins and curve colloidal gold one positive her (which can be tabetic or paretic) .the CSF changes depend on the disease activity. Pre-treatment tends to minimize disruptions.

Prognosis: Treatment can clarify meningovascular injury completely. The results are poor in cases established atrophy tabes and optc. GPI may occur a considerable improvement.

Treatment: It manages a penicilina.Cursos repeated may be required and this has to be decided depending on blood and CSF serology repeated at 6 and 12 months after the initial treatment. Dolores tabetic may respond to analgesics and carbamazepine in a dose of 100 mg three times daily. Visceral crisis discusses sedation and support measures.

Gumma central nervous system

Gumma occurs in the third stage of syphilis. pathologically, the Gumma consist of deposition of collagen, forming an amorphouse matric lymphocytes and multinucleated giant cells in the Center and edge plasma cells. T.pallidum is not provable in these lesiones.Marcelaa can be seen in various situations Cranial Dural, leptomeningeal, cerebral and spinal vertebral.estas behave like space-occupying lesions. antisyphilitic treatment response is poor.Line of treatment is excise duty injuries and give antisyphilitic therapy.

Syphilitic deafness: deafness may derive several reasons at different stages of the sifilis.puede result of affection of the cochlea, acoustic nerve, basal meninges or damage in ear half.

Slow virus infections

Some viruses are able to stay inactive in nervous tissue for long periods and produce damage during several years.These are characterized by long period of incubation, slow course progressive and in many cases a fetal termination.The following two groups are distinguished:

1. In the first group, viral agents are identifiable as Subacute Sclerosing Panencephalitis and progressive, multifocal leuconencephalopathy
2. In the second group, viruses have not been clearly identified, are resistant to antiviral medications, and them not evoke marked antibody response e.g., Kuru and Jakob-Crutzfeldt diseases.

Subacute Sclerosing Panencephalitis (SSPE) is caused by the measles virus.Occurs in children. cause serious anomalies intellectual functions and other motor disturbances and sensoriales.La disease follows a course of 3.9 months end fatalmente.En Kuru and Creutzfeldt Jakob - disease, there is strong evidence of a viral etiology, however, the real viruses have not been progressive multifocal identificados.Leucoencefalopatia (PML) is caused by a virus (SV 40 Jc Virus) Papoa .conduce to progressive demyelination occurring multifocally.PML is seen in partnership with the States of immunocompromised and lymphomas.

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Infections of central nervous system (neurosyphilis)

Infections usually involve the invasion of pathogenic microbes in systems of the body or bodies, causing damage or alteration of the organ or system functions. The type system is no exception and one invasive disorders is syphilitic lesions causing neurosyphilis and many infections that occur due to this, is the Meningovascular syphilis (tertiary neurosyphilis early).

Neurosyphilis

Involvement of the nervous system in syphilis used to be common before of the 1950s, but is now clearly rare to see new cases.Neurological injuries are caused by the invasion of the tissues by T.pallidum.Neurological involvement occurs in 4% of cases of syphilis without tratamiento.Hombres are affected 4-5 times more than the females. meningovascular participation is more common in the India, comprising 60-70% of the total.

Syphilitic injuries

1. Secondary meningitis stage
2 Stage tertiary
I Meningovascular syphilis: meningitis forms Basal Cerebral, pachymeningitis, vascular Thrombosis due to endarteritis, optic atrophy and Gumma. The backbone of forms-Meningomyelitis of Erb paraplegia cervical pachymeningitis, syphilitic amyotrophy, radiculitis, Gumma.
II. parenchymal participation: cerebral palsy generally Loco (IPG). Form of spinal vertebral Tabes dorsalis, optic atrophy.
3. Participation of congenital syphilis-Meningovascular atrophy optic, deafness, general paresis of the mentally ill and tabes.

Meningovascular syphilis (tertiary neurosyphilis early)

In this way, the most common injury is leptomeningitis. The lesions occur on the basis of the brain and hemispheres. Basal meningitis may involve cranisl cranial nerve palsies and occlusion of the hole towards the internal Hydrocephalus nerves. Main injury is endarteritis obliterans. The intimate is supplied, the vessel wall displays infiltration by plasma cells and lymphocytes. Supervenes in thrombosis and this obstructs the lumen.Granulomatous changes are also observed. Less often, duramater on cerebral hemispheres can participate in the process granulomatous thickening (cerebral pachymeningitis).

Clinical features

Brain forms: syphilitic meningitis sees in the 18-40 years age group.Basal syphilitic meningitis leads to a subacute or chronic meningitis which is characterized by headache, cranial nerve palsies, raised tension intra-beats and signs of meningeal irritation.CSF shows high protein and pleocytosis linfocitica.El sugar and chloride are normal.Cranial Pachymeningitis causes headaches, seizures and neurological deficit focus such as aphasia or hemiparesis.Syphilitic Endarteritis is one of the causes of Occlusive cerebrovascular youth injury.These cases present features of cerebral thrombosis.Facial paralysis of lower motor neuron can occur and the prognosis for recovery trigemino.El neuralgia is good if the condition is diagnosed early and treated.

The backbone of forms: This gives rise to the image of acute transverse myelitis or varying degrees of pain root cord compression.In some, develops spastic paraplegia.In this form (of Erb syphilic paraplegia) bladder dysfunction is common, but sensory symptoms are rare.

Hypertrophic cervical Pachymeningitis: cervical cord compression leads to pain root, weakness and wear of the upper limbs and erect and paraparesia.Tal image is also known as amyotrophy sifilitica.La cauda equina can be involved causing pain of root, areflexia, weakness and wear that affect the thighs and legs.

Optic atrophy: this may be meningo-vascular involvement or parenquimatosa.El first leads to arachnoiditis, optic neuritis or neuritis retrobulbares.estos changes occur during the tertiary phase sifilis.En this stage, no specific treatment can help reverse the condition. optic atrophy occurs as part of parenchymal participation during the final stages.

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