Tabes Dorsalis physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{Tabes dorsalis}}
{{Tabes dorsalis}}
==Physical Examination==
Physical examination may show:
*Damage to the [[spinal cord]] ([[myelopathy]])
*[[Pupil]]s that react abnormally to light
*Reduced or absent reflexes due to nerve damage
==References==
{{Reflist|2}}
[[Category:Needs overview]]
[[Category:Neurology]]
[[Category:Pain]]
{{WH}}
{{WS}}
s
s
s
s


{{CMG}};{{AE}}{{MMJ}}
{{CMG}};{{AE}}{{MMJ}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with tabes dorsalis may be asymptomatic. Physical examination of patients with tabes dorsalis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]], impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
*Physical examination of patients with tabes dorsalis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]], impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]].
*Physical examination of patients with tabes dorsalis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]] (bilateral small pupils that constrict when the patient focuses on a near object, but do ''not'' constrict when exposed to bright light), Impaired vibratory and [[proprioception]] sense, broad base and [[Sensory ataxia|sensory ataxic gait]] and positive [[romberg's test]] (a test used for examination of neurological function for balance).


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with tabes dorsalis usually appear normal.  
*Patients with tabes dorsalis may be asymptomatic.<ref name="pmid26558247">{{cite journal| author=Crozatti LL, de Brito MH, Lopes BN, de Campos FP| title=Atypical behavioral and psychiatric symptoms: Neurosyphilis should always be considered. | journal=Autops Case Rep | year= 2015 | volume= 5 | issue= 3 | pages= 43-7 | pmid=26558247 | doi=10.4322/acr.2015.021 | pmc=4636106 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26558247  }} </ref>


===Vital Signs===
===Vital Signs===


*Usually [[vital signs]] are normal in tabes dorsal.<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Usually [[vital signs]] are normal.<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
===Skin===
===Skin===
* In patients with tabes dorsalis some [[granulomatous]] [[Skin lesion|skin lesions]] which are one of the late manifestations of tertiary syphilis called [[gumma]] may be present. [[Gumma]]<nowiki/>s, are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].<ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref>
Important cutanous findings in tabes dorsalis include:
*[[Jaundice]] may be seen.
* [[granulomatous]] [[Skin lesion|skin lesions]]:
** One of the late manifestations of [[tertiary syphilis]] called [[gumma]] may be present
** [[Gumma]]<nowiki/>s are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].<ref name="pmid21694502">{{cite journal| author=Carlson JA, Dabiri G, Cribier B, Sell S| title=The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. | journal=Am J Dermatopathol | year= 2011 | volume= 33 | issue= 5 | pages= 433-60 | pmid=21694502 | doi=10.1097/DAD.0b013e3181e8b587 | pmc=3690623 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694502  }} </ref>
 
*[[Jaundice]]




Line 60: Line 29:


===HEENT===
===HEENT===
 
Abnormalities of the [[head]] include:<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref><ref name="pmid1195972">{{cite journal| author=Nadol JB| title=Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy. | journal=Laryngoscope | year= 1975 | volume= 85 | issue= 11 pt 1 | pages= 1888-97 | pmid=1195972 | doi=10.1288/00005537-197511000-00012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1195972  }} </ref>
* Abnormalities of the [[head]] include:
* Icteric sclera may be present
* Icteric sclera may be present
*[[Argyll Robertson pupil|Argyll Robertson pupils]] may be present<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref>
*[[Argyll Robertson pupil|Argyll Robertson pupils]] may be present
* Hearing acuity may be reduced<ref name="pmid1195972">{{cite journal| author=Nadol JB| title=Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy. | journal=Laryngoscope | year= 1975 | volume= 85 | issue= 11 pt 1 | pages= 1888-97 | pmid=1195972 | doi=10.1288/00005537-197511000-00012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1195972  }} </ref>
* Hearing acuity may be reduced


===Neck===
===Neck===
*Nontender, mobile, small, cervical [[lymphadenopathy]] may be present
*Cervical [[lymphadenopathy]]  
**Nontender
**Mobile
**Small


===Lungs===
===Lungs===
* In patients with tabes dorsalis some [[granulomatous]] lung lesions which are one of the late manifestations of [[tertiary syphilis]] called [[gumma]] may be present. [[Gumma]]<nowiki/>s, are [[granulomatous]] reactions to long-term smoldering infection with [[Treponema pallidum]] and its residual [[Antigen|antigens]].<ref name="pmid14931376">{{cite journal| author=MORGAN AD, LLOYD WE, PRICE-THOMAS C| title=Tertiary syphilis of the lung and its diagnosis. | journal=Thorax | year= 1952 | volume= 7 | issue= 2 | pages= 125-33 | pmid=14931376 | doi= | pmc=1019150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14931376  }} </ref>
* [[Granulomatosis]] manifestations in lungs<nowiki/><ref name="pmid14931376">{{cite journal| author=MORGAN AD, LLOYD WE, PRICE-THOMAS C| title=Tertiary syphilis of the lung and its diagnosis. | journal=Thorax | year= 1952 | volume= 7 | issue= 2 | pages= 125-33 | pmid=14931376 | doi= | pmc=1019150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14931376  }} </ref>
*Bilaterally coarse [[crackles]] upon auscultation of the [[lung]] may be present
*Bilaterally coarse [[crackles]]


===Neuromuscular===
===Neuromuscular===
*Positive [[Romberg's test|romberg test]] is one of the most important findings in [[physical examination]] of patients with tabes dorsalis<ref name="pmid17235095">{{cite journal| author=French P| title=Syphilis. | journal=BMJ | year= 2007 | volume= 334 | issue= 7585 | pages= 143-7 | pmid=17235095 | doi=10.1136/bmj.39085.518148.BE | pmc=1779891 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17235095  }} </ref>
*Positive [[Romberg's test|romberg test]] (a test used for examination of neurological function for balance) is one of the most important findings in [[physical examination]] of patients with tabes dorsalis<ref name="pmid17235095">{{cite journal| author=French P| title=Syphilis. | journal=BMJ | year= 2007 | volume= 334 | issue= 7585 | pages= 143-7 | pmid=17235095 | doi=10.1136/bmj.39085.518148.BE | pmc=1779891 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17235095  }} </ref>
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time
* [[Hyporeflexia]] or [[areflexia]] may be seen<ref name="pmid22330117">{{cite journal| author=Pandey S| title=Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. | journal=J Spinal Cord Med | year= 2011 | volume= 34 | issue= 6 | pages= 609-11 | pmid=22330117 | doi=10.1179/2045772311Y.0000000041 | pmc=3237288 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330117  }} </ref>
* [[Hyporeflexia]] or [[areflexia]]<ref name="pmid22330117">{{cite journal| author=Pandey S| title=Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. | journal=J Spinal Cord Med | year= 2011 | volume= 34 | issue= 6 | pages= 609-11 | pmid=22330117 | doi=10.1179/2045772311Y.0000000041 | pmc=3237288 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330117  }} </ref>
* Impaired balance bilateral [[Babinski's Reflex]] may be present<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
* Impaired balance bilateral [[Babinski's Reflex]]<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
* Bilateral [[muscle weakness]] mostly in [[lower limbs]] may be seen<ref name="pmid16778468">{{cite journal| author=Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R| title=Neurosyphilis manifesting as spinal transverse myelitis. | journal=Medicina (Kaunas) | year= 2006 | volume= 42 | issue= 5 | pages= 401-5 | pmid=16778468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16778468  }} </ref>
* Bilateral [[muscle weakness]] mostly in [[lower limbs]]<ref name="pmid16778468">{{cite journal| author=Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R| title=Neurosyphilis manifesting as spinal transverse myelitis. | journal=Medicina (Kaunas) | year= 2006 | volume= 42 | issue= 5 | pages= 401-5 | pmid=16778468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16778468  }} </ref>
* [[Argyll Robertson pupil|Argyll Robertson pupils]] may be present<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref>
* [[Argyll Robertson pupil|Argyll Robertson pupils]] (bilateral small pupils that constrict when the patient focuses on a near object, but do ''not'' constrict when exposed to bright light)<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref>
*Bilateral [[sensory loss]] in the extremity mostly in [[lower limbs]] may be seen<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Bilateral [[sensory loss]] mainly in lower extremities<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Broad base gate and [[Sensory ataxia|Sensory ataxic gait]] is usually seen in patients with tabes dorsalis<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Broad base gait
*[[Cranial nerve palsy]] caused by [[gummatous]] [[neurosyphilis]] may be seen<ref name="pmid8279327">{{cite journal| author=Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J| title=Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings. | journal=AJNR Am J Neuroradiol | year= 1993 | volume= 14 | issue= 6 | pages= 1329-31 | pmid=8279327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8279327  }} </ref>
*[[Sensory ataxia|Sensory ataxic gait]]<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*[[Cranial nerve palsy]] ([[Diplopia|diplopia,]] [[mydriasis]]) caused by [[gummatous]] [[neurosyphilis]]<ref name="pmid8279327">{{cite journal| author=Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J| title=Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings. | journal=AJNR Am J Neuroradiol | year= 1993 | volume= 14 | issue= 6 | pages= 1329-31 | pmid=8279327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8279327  }} </ref>
*Finger-to-nose test is usually abnormal<ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420  }} </ref>
*Finger-to-nose test is usually abnormal<ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420  }} </ref>
===Extremities===
* [[Charcot joint|Charcot arthropathy]] ([[Charcot joint]]) of the foot<ref name="pmid23919113">{{cite journal| author=Kaynak G, Birsel O, Güven MF, Oğüt T| title=An overview of the Charcot foot pathophysiology. | journal=Diabet Foot Ankle | year= 2013 | volume= 4 | issue=  | pages=  | pmid=23919113 | doi=10.3402/dfa.v4i0.21117 | pmc=3733015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23919113  }} </ref>


===Extremities===
*Muscle atrophy
[[Charcot joint|Charcot arthropathy]]([[Charcot joint]]) of the foot may be seen<ref name="pmid23919113">{{cite journal| author=Kaynak G, Birsel O, Güven MF, Oğüt T| title=An overview of the Charcot foot pathophysiology. | journal=Diabet Foot Ankle | year= 2013 | volume= 4 | issue=  | pages=  | pmid=23919113 | doi=10.3402/dfa.v4i0.21117 | pmc=3733015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23919113  }} </ref>
*Muscle atrophy may be present


==References==
==References==

Latest revision as of 20:38, 1 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Patients with tabes dorsalis may be asymptomatic. Physical examination of patients with tabes dorsalis is usually remarkable for: Argyll-Robertson pupils, impaired vibratory and proprioception sense, broad base and sensory ataxic gait and positive romberg's test.

Physical Examination

  • Physical examination of patients with tabes dorsalis is usually remarkable for: Argyll-Robertson pupils (bilateral small pupils that constrict when the patient focuses on a near object, but do not constrict when exposed to bright light), Impaired vibratory and proprioception sense, broad base and sensory ataxic gait and positive romberg's test (a test used for examination of neurological function for balance).

Appearance of the Patient

  • Patients with tabes dorsalis may be asymptomatic.[1]

Vital Signs

Skin

Important cutanous findings in tabes dorsalis include:


Tertiary syphilis gumma
Source:By NearEMPTiness (Wie Schönes Wissen schafft im MUT) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons, rID: 51340


HEENT

Abnormalities of the head include:[4][5]

Neck

Lungs

Neuromuscular

Extremities

  • Muscle atrophy

References

  1. Crozatti LL, de Brito MH, Lopes BN, de Campos FP (2015). "Atypical behavioral and psychiatric symptoms: Neurosyphilis should always be considered". Autops Case Rep. 5 (3): 43–7. doi:10.4322/acr.2015.021. PMC 4636106. PMID 26558247.
  2. 2.0 2.1 2.2 Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 160–3. PMC 2582679. PMID 19148316.
  3. Carlson JA, Dabiri G, Cribier B, Sell S (2011). "The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity". Am J Dermatopathol. 33 (5): 433–60. doi:10.1097/DAD.0b013e3181e8b587. PMC 3690623. PMID 21694502.
  4. 4.0 4.1 Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". J Neuroophthalmol. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
  5. Nadol JB (1975). "Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy". Laryngoscope. 85 (11 pt 1): 1888–97. doi:10.1288/00005537-197511000-00012. PMID 1195972.
  6. MORGAN AD, LLOYD WE, PRICE-THOMAS C (1952). "Tertiary syphilis of the lung and its diagnosis". Thorax. 7 (2): 125–33. PMC 1019150. PMID 14931376.
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