Assuntos
Doenças do Sistema Nervoso Central/patologia , Córtex Cerebral/patologia , Gânglios da Base/patologia , Tronco Encefálico/patologia , Doenças do Sistema Nervoso Central/classificação , Cerebelo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos/patologia , Medula Espinal/patologiaRESUMO
The clinical features of 206 cases of a neuropathic syndrome in Jamaica are presented. The dominant feature is a spastic paraplegia. Approximately half of the cases have evidence of associated posterior column damage. In a minority optic atrophy, nerve deafness of selective anterior horn cell damage is found. The patients have been divided arbitrarily into two categories: 25 cases presenting predominantly with sensory ataxia, and in whom there is a high incidence of optic atrophy and eighth nerve deafness, with slight evidence of pyramidal tract damage. This group has a background of poor nutrition. (b) 181 cases presenting predominantly as a spastic myelopathy, and with a relative low incidence of optic atrophy and eight nerve deafness. The findings in ten necropsies from the spastic group are presented with their cases record. The histopathology is that of a chronic meningo-myelitis, with damage to the long tracts as the major lesion. Involvement of the brain, they grey matter of the cord and spinal nerve roots occurs to a lesser extent. An eleventh case is described with similar pathology, which clinically was thought to be an example of neurosyphilis. The relationship of this syndrome to other neuropathies is considered. The aetiology is discussed, with special reference to the possible role of syphilis and yaws in the spastic group. The majority of these cases have positive treponemal tests in the blood, but only 6 per cent have positive tests in the spinal fluid. The pathology has much in common with that of neurosyphilis, but lacks some of the features generally accepted as typical. The incidence is extremely high relative to other known forms of neurosyphilis in Jamaica. Other factors such as ingested toxins and vitamin deficiences may add to, or modify, the metabolic impairment. It is possible to envisage a spectrum of disease varying from a picture of non-inflammatory long tract degeneration to the active meningo-vascular reaction of florid adhesive arachnoiditis-a spectrum in which common causal factors could operate with variable degrees of intensity. This study emphasizes that our understanding of the pathogenesis and pathology of neurosyphilis in its many forms is far from complete (AU)
