LOCOMOTOR ATAXIA. Tabes dorsalis. Posterior Spinal Sclerosis)

Category: Diseases of The Nervous System

A
hardening (sclerosis) affecting the posterior parts of the spinal cord and
characterized by incoordination, which means a condition where a person is
unable to produce voluntary muscular movements; for instance, of the legs,
etc., loss of deep reflexes to bend them back; disturbances of nutrition
and sensation, and various affections of sight.

Causes. This is a disease of adult life, persons under twenty-five being
rarely affected, and is more common in men than women (ten to one).
Sometimes children suffering from hereditary syphilis have it. The chief
predisposing cause is syphilis which precedes it in from seventy to
eighty-five of the cases according to various authorities. Exposure to
cold and wet, sexual and alcoholic excesses, mineral poisoning, and great
physical exertion also exciting causes.

Symptoms. These are numerous. They appear in succession and with the same
regularity.

Stages. Stages of pain; the stage of ataxia, peculiar gait; and the state
of paralysis.

1. Prodromal or forerunning; the stage of pain. This consists of
lightning-like pains in the lower extremities, numbness, formication
(feeling of ants, etc., crawling), sensation of dead extremities; pins and
needles in the soles of the feet and fingers, coldness, itching of arms
and scrotum or other parts, a sensation of constriction around the chest,
headache, pain in the small of the back and loins of an aching character
may occur. These symptoms may constitute the only evidence of locomotor
ataxia and last for years; but sooner or later there are added absence of
knee cap bone reflex (knee jerk), and immobility of the pupil. The loss of
the knee jerk is always observed in time. The pupil fails to respond to
light while it still accommodates for distance, called Argyll Roberston
pupil. There may be imperfect control of the bladder with slow, dripping
or hasty urination. Later the control is not imperfect, but it may be
painful. Inflammation of the bladder may occur which is dangerous. There
is usually obstinate constipation and loss of sexual power. These symptoms
may last for several months and years, and then the second stage symptoms
appear.

2. Stage of Ataxia (Disturbance of motion). The disturbance of motion
(ataxia) is very marked, especially in the lower extremities; the walking
becomes difficult and uncertain; there is difficulty in rising or rapid
turning; the legs are wide apart; feet lifted too high and come down too
forcibly; the length of the steps is irregular, and the body is
imperfectly balanced. If the patient stands with his feet together and
eyes closed he begins to sway, (Romberg's symptom), which is due to a
defect in controlling the muscles from impairment of sensation. There may
be imperfect use of the hands in dressing, writing, etc.; lancinating
pains are marked in all cases and come on in paroxysms. The pains are
mostly in the legs, but also occur in the arms, head, loins, back, and
trunk. Then the sense of touch is partially lost. The prick of a pin may
not be felt until a few seconds after being applied. This stage may last
for years and remain at a "standstill;" but it is usually progressive, and
advances to the third stage.

3. The stage of paralysis is marked by a gradual change to the worse, and
the patient must remain in bed, because he cannot get out. The lower and
sometimes the upper extremities have lost a great deal of their power of
sensation: The joints, mostly the knee and hip joints show on both sides
of the body a painless swelling, owing to the great quantities of watery
liquid there. Dislocations and fractures occur simultaneously. Bed-sores
and peculiar ulcers on the sole of the foot also occur. The urine dribbles
away constantly, for all control of the bladder is lost. Death occurs from
exhaustion; bedsores, inflammation of the bladder, or pneumonia coming on
as a complication.

Treatment;--The only thing to do when the patient has this disease is to
make him comfortable and arrest the progress of it, if possible. It is
incurable, but treatment sometimes arrests the progress and at least
lessens the suffering and prolongs life as long as it is worth living to
them. I have given a longer description than was necessary, for I wanted
men who live such fast lives to understand what it brings them for most
cases are caused by syphilis. The description could have been made longer
and other symptoms and complications put in. I think enough has been given
and perhaps this description may deter some one from going the same road.

The Diagnosis is made at first by the fatigue, peculiar pains, loss of the
knee jerk, the peculiar pupil and history of syphilis. Later it is made
from the ataxia; the peculiar walk, etc., and the bladder disturbances.

Next: HEREDITARY ATAXIA. Friedrich's Disease
Previous: MYELITIS

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LOCOMOTOR ATAXIA. Tabes dorsalis. Posterior Spinal Sclerosis)