Spinal cord dryness is a clinical variant of neurosyphilis caused by degenerative changes in the posterior spinal cord. The dominant signs in the clinical picture are: increasing ataxia, impaired pupillary reactions, sensitivity disorders, paroxysmal pain. Diagnosis of spinal cord disease occurs according to the characteristic symptoms, the results of laboratory diagnostics (analysis of cerebrospinal fluid and blood samples for the presence of pale treponema), an ophthalmological examination, and neurological status. Therapy is based on the etiotropic treatment with antibiotic cefriaxone, penicillin series.
Causes of the development of the disease
The dryness of the spinal cord develops due to damage to the horns, pillars, posterior roots of the spinal cord of a pale treponema. This is a causative agent of syphilis, belonging to the class of spirochetes. Spinal cord is a tertiary syphilis that develops long after infection with treponemas. To find out the exact causes of an isolated spinal cord lesion, medicine failed. Some researchers tend to associate it with a change in the biological properties of treponema in the process of long-term persistence. Other scientists suggest that treponemas have different neurotropism.
Predisposing factors for the development of pathology
Among the factors predisposing to the development of pathology are:
- Alcoholism.
- Chronic pathology.
- Immunodeficiency caused by HIV infection.
- Incorrect or incomplete treatment of early forms of syphilis.
This is only a small part of what can cause a disease.
Tabes classification
The classical form of Tabes can have 3 forms of development. The most common rudimentary forms of pathology, which are represented by 1 or 2 periods. For the spinal cord, the erased course of the disease is characteristic, there is no clear phasing. But understanding the stages of development of pathology is still clinically significant. Given this criterion, doctors distinguish 3 stages of development of spinal cord:
- Preatactic (primary, neuralgic). This phase of development is characterized by reduced tendon reflexes, sensitivity disorders, pain. Typical manifestations are: urinary retention, staging crises. Often there are violations in the functionality of the nerves of the skull.
- Ataxic. It is characterized by the development of sensitive ataxia. The patient's gait changes, walking becomes difficult. In addition, trophic disorders occur and progress.
- Paralytic. The patient develops paresis of the legs of the peripheral type, he completely loses the ability to move due to arthropathy, due to the lack of sensitivity in the muscles and joints.
Symptoms of spinal cord
Photos of patients with this pathology are often searched online. At the initial stages of the development of the disease, the patient has cutting, paroxysmally shooting, painful sensations. Most often spread from the lumbar to the lower extremities, however, their localization may be different, corresponding to the level of damage to the spinal cord. In approximately 15% of patients, pain syndromes occur in the form of visceral type of tabular crises.
An excruciating symptom of a dry spinal cord is a shooting neuralgic pain in the legs, which is sometimes mistaken for sciatica or "flying rheumatism." This can be explained by damage to the posterior roots of the spinal cord, fiber irritation, which is responsible for pain and temperature sensitivity. Neuralgic vegetative pains are also observed from the side of internal organs. The patient feels a burning sensation in the stomach, he can’t eat anything, drinks cold water to somewhat calm this unpleasant symptomatology.
Gastric crises are similar to pain arising from ulcerative lesions. Intestinal crises are characterized by the occurrence of pain along the lower gastrointestinal tract, the development of diarrhea, tenesmus. With laryngeal crises, a feeling of suffocation is noted, a cough of a paroxysmal nature develops. With cardiac crises, the symptomatology resembles an angina attack, with hepatic crises - hepatic colic.
What are the symptoms of spinal cord dryness?
Sensory Disorders
Tabes is distinguished by the initial development of a disorder of deep muscular-articular, vibrational sensitivity, after which violations of surface perception (tactile, thermal, pain) appear. Most of all the changes are expressed in the lower extremities, the early stages of development of the spinal cord are accompanied by hyperpathy, paresthesia. Often there is a development of muscle hypotension, a decrease, a complete loss of Achilles, knee reflexes, a violation of the functionality of the pelvic organs. As the pathology develops, sensitive disorders progress and lead to the occurrence of sensitive ataxia. First, the patient notes the difficulties that arise when walking in the dark. Then there are complaints of shakiness when walking, insecurity of movements, loss of stability, regardless of lighting.
Pupillary Disorders
Among the early manifestations of dryness of the spinal cord, pupil disorders should also be noted: the absence of a pupil reaction while maintaining accommodation (Argyll-Robertson symptom), a change in the shape of the pupil, miosis, anisocoria. As a result of damage to the second pair of optic nerves, a decrease in visual acuity occurs. Dysfunctions of the third, fourth, fifth pairs of cranial nerves are noted. No less characteristic are trophic disorders: arthropathy develops, trophic ulcers appear on the feet, hair falls out, the skin becomes dry and thins. Movement disorders are aggravated by joint deformation.
Symptoms of spinal cord should not be ignored.
Complications
Muscular hypotension, joint changes, increasing ataxia become the reason that the patient loses the ability to move independently and becomes bedridden. High danger is the development of pressure sores, secondary infection of the skin, genitourinary organs with pathogenic and bacterial flora. Probably the development of pyelonephritis, urethritis, cystitis. The most dangerous infectious complication of spinal cord is sepsis. The progression of atrophic changes in the optic nerve can provoke complete blindness. If the syphilitic process extends to the lining of the spinal cord or parenchyma, spinal dryness may be complicated by symptoms of progressive paralysis - increasing dementia, mental disorders.
Diagnostics
Diagnosis of spinal bark allows the history of information about past syphilis, the presence of typical clinical criteria (progressive ataxia, hyporeflexia, Argyll-Robertson symptom, and deep sensitivity disorder), laboratory evidence of syphilitic etiology. The data obtained with CT and MRI of the spine are non-specific, but in complex diagnostic cases they can differentiate the spinal cord from vertebrogenic disorders, spinal cord tumors, and spinal abscesses. In the general list of diagnostic measures are:
- Neurologist examination. During a neurological examination, the specialist determines the level of decrease in deep sensitivity, the degree of suppression of tendon reflexes, the moderation of paresis of the legs, the severity of muscle hypotension. The disease can be indicated by the shakiness during the Romberg test, the presence of a tabetic gait with strong heel hits on the floor surface. In addition, the symptom of Abadi is characteristic of the dorsal dryness - the patient does not feel pain during compression of the Achilles tendon.
- Consultation of an ophthalmologist. During visometry, a significant degree of decrease in visual acuity is determined. With ophthalmoscopy, symptoms of atrophic changes in the optic nerve are diagnosed. Diagnosis of symptoms of spinal cord should be comprehensive.
- Laboratory diagnostics. RPGA, RIF, RPR test - standard serological tests performed on blood and cerebrospinal fluid obtained by lumbar puncture. It is worth noting that in some patients the results of these studies show a negative result. In such cases, an additional immobilization reaction by treponem is indicated. In approximately 95% of cases, this test gives a positive result.
- X-ray of the joints. An X-ray examination of deformed joints reveals necrotic changes on the surfaces of the joints, subluxations, intraarticular fractures, and the presence of bone fragments in the joint cavity. Osteosclerosis is often noted.
Differential diagnosis
Tabes is subject to differentiation with funicular myelosis, discogenic myelopathy, cauda equina tumor, radicular syndrome of vertebrogenic type, polyneuropathy, Friedreich's ataxia, Charcot-Marie-Tooth amyotrophy. You should also differentiate visceral crises from renal, hepatic colic, enterocolitis, stomach ulcers, coronary heart disease. During the diagnosis, the need for an additional examination by a gastroenterologist, nephrologist, cardiologist may arise.
Treatment of spinal cord
The basis of therapy is etiotropic treatment. Since pale treponema is sensitive to penicillin medicines, the base drug is benzylpenicillin salt. In order to achieve the required treponemocidal concentration of the antibacterial agent in the cerebrospinal fluid, intravenous injections are indicated daily for 2-3 weeks. In some cases, the use of bismuth-based medicines is recommended.
With hypersensitivity to penicillin
If the patient has hypersensitivity to penicillin preparations, a two-week parenteral administration of ceftriaxone-based drugs is indicated. To restore neural functions, neurometabolic and vascular therapy is carried out in parallel with B vitamins, vasoactive drugs that activate metabolism. Physical therapy is also recommended for patients. The results of therapy are evaluated according to the results of control laboratory studies of cerebrospinal fluid.
Symptoms and treatment of spinal cord disease are extremely important to know even for those who have never encountered this pathology.