Tabes Dorsalis physical examination: Difference between revisions
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with tabes dorsalis may be asymptomatic. | *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>6 | ||
===Vital Signs=== | ===Vital Signs=== | ||
Revision as of 20:23, 1 March 2018
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Tabes Dorsalis Microchapters |
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Treatment |
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Tabes Dorsalis physical examination On the Web |
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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, impaired vibratory and proprioception sense, broad base and sensory ataxic gait and positive romberg's test.
Appearance of the Patient
- Patients with tabes dorsalis may be asymptomatic.[1]6
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 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[4]
- Bilateral sensory loss mainly in lower extremities[2]
- Broad base gait
- Sensory ataxic gait[2]
- Cranial nerve palsy 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.