Syphilis of the vertebral column : its symptomatology and neural complications / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1914
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Licence: In copyright

Credit: Syphilis of the vertebral column : its symptomatology and neural complications / by J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tliesia of one upper or lower extremity indicated a radicular origin. Such an involvement of the roots or plexus producing monoplegia alone must he a rare occurrence in Pott’s disease, and when it is present should arouse the suspicion of syphilis. In 2 cases of sacral origin the symptoms indicated an involve- ment of the strands of the cauda equina. An unusual complication occurred in Case III of my series, a cervical spondylitis, with symptoms indicating a lesion of the medulla oblongata, possibly from involvement of the vertebral artery as it courses through the transverse processes in the neck. Of special interest is tlie occurrence of root pains, paresthesia, and localized paralysis of an extremity corresponding to the region involved. This group of cases is particularly frequent in the cervical region, and may simulate pachymeningitis cervicalis hyi)ertrophica. Sachs especially has emphasized this resemblance, and advocates the a:-rays as an important means of differentiation. Similar cases are also met with in the lumbar region, and may he unilateral or bilateral in distribution, due to involvement of the nerve roots or adjacent plexus. It is interesting to note in passing that parasyphilis may also be complicated with syphilitic spondylitis (Hallopeau and Sachs). Of special complications which may occur the most noteworthy is ulceration of the pharynx which was observed in IG cases of the cervical localization (Neumann), and which gave rise in 9 cases to extrusion of fragments of necrosetl and carious bone. Sudden death has occurred from erosion of the vertebral artery (Mackenzie), and once from ulceration and ru])ture of the internal carotid (Landrieux). In common with diseases of the upper cervical verteljne, the odontoid process may undergo spontaneous fracture with com- pression of the cord. REPORT OF CASES. Case I.—Syphilis of the skull {exostoses) and knee-joint, and syphilitic laryngitis preceded the development of vertebral symptoms; these came on suddenly in the upper cervical region, simulating rheu- matic myositis; x-ray examination was negative; girdle pains around the base of the neck and lancinating pains in the distribution of the occipital nerves were the only nerve complications; gradual subsidence of pain under antisyphilitic treatment; rigidity persisted for some months, but gradually disappeared with complete restoration of functions. History. The patient, a man, aged forty-three years, an expert accountant by occupation, was referred to me on April 7, 1910, by Dr. Frank W. Murray, for severe headache which had persisted for over a year. He had pneumonia at the age of seventeen years