Tabes Dorsalis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tabes dorsalis}} | {{Tabes dorsalis}} | ||
{{CMG}};{{AE}}{{MMJ}} | {{CMG}};{{AE}}{{MMJ}} | ||
==Overview== | ==Overview== | ||
Patients with | 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]]. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with tabes dorsalis is usually remarkable for: [[Argyll Robertson pupil|Argyll-Robertson pupils]], | *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 | *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 | *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=== | ||
Important cutanous findings in tabes dorsalis include: | |||
*[[Jaundice]] | * [[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> | |||
* Icteric sclera may be present | * Icteric sclera may be present | ||
*[[Argyll Robertson pupil|Argyll Robertson pupils]] may be present | *[[Argyll Robertson pupil|Argyll Robertson pupils]] may be present | ||
* Hearing acuity may be reduced | * Hearing acuity may be reduced | ||
===Neck=== | ===Neck=== | ||
* | *Cervical [[lymphadenopathy]] | ||
**Nontender | |||
**Mobile | |||
**Small | |||
===Lungs=== | ===Lungs=== | ||
* | * [[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]] | *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]] | * [[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]] | * 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]] | * 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]] | * [[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 | *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 | *Broad base gait | ||
*[[Cranial nerve palsy]] caused by [[gummatous]] [[neurosyphilis]] | *[[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> | |||
*Muscle atrophy | |||
*Muscle atrophy | |||
==References== | ==References== | ||
Latest revision as of 20:38, 1 March 2018
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Tabes Dorsalis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Tabes Dorsalis physical examination On the Web |
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American Roentgen Ray Society Images of Tabes Dorsalis physical examination |
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Risk calculators and risk factors for Tabes Dorsalis physical examination |
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
- Usually vital signs are normal.[2]
Skin
Important cutanous findings in tabes dorsalis include:
- granulomatous skin lesions:
- One of the late manifestations of tertiary syphilis called gumma may be present
- Gummas are granulomatous reactions to long-term smoldering infection with Treponema pallidum and its residual antigens.[3]
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]
- Icteric sclera may be present
- Argyll Robertson pupils may be present
- Hearing acuity may be reduced
Neck
- Cervical lymphadenopathy
- Nontender
- Mobile
- Small
Lungs
- Granulomatosis manifestations in lungs[6]
- Bilaterally coarse crackles
Neuromuscular
- Positive 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[7]
- Patient is usually oriented to persons, place, and time
- Hyporeflexia or areflexia[8]
- Impaired balance bilateral Babinski's Reflex[9]
- Bilateral muscle weakness mostly in lower limbs[10]
- 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)[4]
- Bilateral sensory loss mainly in lower extremities[2]
- Broad base gait
- Sensory ataxic gait[2]
- Cranial nerve palsy (diplopia, mydriasis) caused by gummatous neurosyphilis[11]
- Finger-to-nose test is usually abnormal[12]
Extremities
- Charcot arthropathy (Charcot joint) of the foot[13]
- Muscle atrophy
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 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.
- ↑ 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.
- ↑ French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
- ↑ Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
- ↑ Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M (2009). "Case of neurosyphilis presented as recurrent stroke". Oman Med J. 24 (2): 134–6. doi:10.5001/omj.2009.29. PMC 3273935. PMID 22334859.
- ↑ Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R (2006). "Neurosyphilis manifesting as spinal transverse myelitis". Medicina (Kaunas). 42 (5): 401–5. PMID 16778468.
- ↑ Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J (1993). "Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings". AJNR Am J Neuroradiol. 14 (6): 1329–31. PMID 8279327.
- ↑ Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD (2009). "Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report". Cases J. 2: 8334. doi:10.4076/1757-1626-2-8334. PMC 2769430. PMID 19918420.
- ↑ Kaynak G, Birsel O, Güven MF, Oğüt T (2013). "An overview of the Charcot foot pathophysiology". Diabet Foot Ankle. 4. doi:10.3402/dfa.v4i0.21117. PMC 3733015. PMID 23919113.