LOCOMOTOR ATAXIA. Tabes dorsalis. Posterior Spinal Sclerosis)

Categories: 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 eing

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.