Symptoms

Axial section of the spinal cord showing syphilitic destruction (whitened area, upper center) of
the posterior columns which carry sensory information from the body to the brain

Symptoms may not appear for some decades after the initial infection and include: weakness,
diminished reflexes, paresthesias (shooting and burning pains, pricking sensations, and
formication), hypoesthesias (abnormally diminished cutaneous, especially tactile, sensory
modalities), tabetic gait (locomotor ataxia), progressive degeneration of the joints, loss of
coordination, episodes of intense pain and disturbed sensation (including glossodynia),
personality changes, dementia, deafness, visual impairment, positive Romberg's test, and
impaired response to light (Argyll Robertson pupil). The skeletal musculature is hypotonic due to
destruction of the sensory limb of the spindle reflex. The deep tendon reflexes are also
diminished or absent; for example, the "knee jerk" or patellar reflex may be lacking (Westphal's
sign). A complication of tabes dorsalis can be transient neuralgic paroxysmal pain affecting the
eyes and the ophthalmic areas, previously called "Pel's crises" after Dutch physician P.K. Pel.
Now more commonly called "tabetic ocular crises," an attack is characterized by sudden, intense
ocular pain, lacrimation and photophobia.[1] [2]

"Tabes dorsalgia" is a related back pain.

"Tabetic gait" is a characteristic high-stepping gait of untreated syphilis where the patient's feet
slap the ground as they strike the floor due to loss of proprioception.

[edit] Prognosis
Left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness. Existing nerve
damage cannot be reversed.

[edit] Epidemiology
The disease is more frequent in males than in females. Onset is commonly during mid-life. The
incidence of tabes dorsalis is rising, in part due to co-associated HIV infection.

[edit] Treatment
Penicillin, administered intravenously, is the treatment of choice. Associated pain can be treated
with opiates, valproate, or carbamazepine. Patients may also require physical therapy to deal
with muscle wasting and weakness. Preventive treatment for those who come into sexual contact
with an individual with syphilis is important.

[edit] Trivia
Sir Arthur Conan Doyle, author of the Sherlock Holmes stories, completed his doctorate on tabes
dorsalis in 1885.[3]

[edit] Notable sufferers

 The French novelist Alphonse Daudet kept a journal of the pain