Meningovascular syphilis of the spinal cord
Meningovascular syphilis of the spinal cord consists principally of syphilitic meningomyelitis (the most common form) and spinal vascular syphilis (acute syphilitic transverse myelitis). Spinal syphilis has always been rare, representing only about 3% of cases of neurosyphilis . It is almost always associated with cerebral involvement, but the disease of the cord may be preeminent. The basic underlying process is chronic spinal meningitis, which may result in parenchymatous degeneration of the cord directly or as a result of vascular thrombosis.
Signs and symptoms
Syphilitic meningomyelitis usually occurs after a latent period of 20-25 years. The onset is gradual. The earliest symptoms are weakness or paresthesias of the legs, progressing to paraparesis or paraplegia, which is often asymmetric. Urinary and fecal incontinence and variable sensory disorders (pain and paresthesias) in the legs are prominent. On examination, the legs are weak and spastic, an deep tendon reflexes are hyperactive; ankle clonus is present. The most frequent sensory abnormalities are loss of position and vibratory sense in the lower extremities, with a sensory level in about one-third of patients. The clinical picture may be more complex with meningomyelitis develops in the course of tabes or general paresis, or when spinal artery thrombosis supervenes, changing the spastic paraparesis to a flaccid paraplegia The classic manifestations of spinal vascular syphilis are those of a transection of the spinal cord, usually at a thoracic level, with abrupt onset of flaccid paraplegiam a sensory level on the trunk, and urinary retention.
Blood serologic tests are regularly positive and CSF examination discloses the same abnormalities seen in other forms of syphilis (including a positive VDRL test,) except in burned-out or old, treated cases.
Diagnosis and differential diagnosis
The diagnosis of syphilitic spinal thrombosis is made when flaccid paraplegia develops abruptly in a patient who has consistent CSF abnormalities and reactive blood and CSF serologies. Other causes of acute transverse myelitis must be distinguished.