Progressive paralysis

Progressive paralysis (synonym Bala disease) - organic brain disease syphilis origin determined by the rapid development of dementia (dementia) with neurological symptoms and cachexia. Progressive paralysis often develops from age 30 to 55 years, in 10-15 years after infection with syphilis. Initial symptoms of progressive paralysis lasting from 1 to 6 months, manifested asthenia (see Asthenic syndrome) or depression. These violations are always combined with memory decline, complaining of headache, dizziness, noise in the ears, weakness, indifference to close and their duties, irritability. Criticism for their wrong actions, physical, and especially mental state is missing. In some cases grow only symptoms of total dementia (see) - the so-called simple or Dement, a form of progressive paralysis. Others develop continuing months, at most a year, psychosis: depressed ipohondricescie-nihilistic crazy, maniacal with delusions of grandeur (see Affective syndromes), state resembling catatonia (see Catatonic syndrome), hallucinatory-delusional picture. Any of these psychoses arising in the course of progressive paralysis, always accompanied by symptoms of severe dementia. The last attribute all delusional statements patients absurd character (see also Psevdomatematicheskoe syndrome). Further symptoms of psychosis disappear and foremost a progressive dementia.
Neurological disorders are always appear deserticossus blurred speech, a symptom of Argyll Robertson (see the " dryness " of the Spinal), unstable gait, inaccuracy movements, decrease or absence of knee and Achilles reflexes, reversible mono - or hemiparesis.
From somatic disorders, especially in advanced cases, there are phenomena of cachexia (see), trophic ulcers, fractures of bones, paralysis sphincters. The Wasserman in the blood and cerebrospinal fluid is almost always positive; the number of cellular elements is increased, the amount of protein increased. The combination of progressive paralysis and spinal suchocki (see) is called troparion.
Treatment: mandatory and urgent placement in hospital, where apply the treatment of malaria and antibiotics. If early treatment is possible to achieve recovery.

Progressive paralysis (synonym disease bale) - parenchymal form of neurosyphilis, later syphilis brain damage.
Progressive paralysis usually occurs in 10-15 years after infection, syphilis, often in 40 to 50 years, however, occurs in younger persons In the past progressive paralysis was relatively common disease. In 30-s years of the current century, the incidence of p. P. as in the USSR and abroad is reduced due to the success of prevention and treatment of syphilis.
Pathologist and Cesky PP characterized by phenomena of chronic leptomeningitis, granular ependymoma ventricles of the brain, the inner and outer hydrocephalus, atrophy of brains. In the initial stage PP marked inflammation, later joined by dystrophic changes in the brain tissue.
The clinical picture of progressive paralysis of the combined symptoms of mental, neurological and somatic disorders. According to the degree of clinical manifestations can be distinguished within PP three stages: "neurasthenic" (initial)deployed manifestations of disease, and marasmic.
In the initial stage of progressive paralysis on the first level, there are the so-called neurasthenic effects as fatigue, irritability, reduced working capacity, headaches. The second stage occurs after a few weeks or months. Is characterized by a more profound personality changes. Detected complacency or unmotivated changes of mood from euphoria to outbreaks of irritation or reaction labouche. There are often ridiculous delusions of grandeur: the patients consider themselves owners of huge sums of money, countless riches, the lords of the world, etc., Rarely occurring depressed mood. Identifies and kind coarsening of personality, which is characterized by loss of the sense of tact in dealing with people, violation of social and personal relations. Patients commit aimless shopping, spending money, regardless of financial status of the family. Gradually increase the memory disturbance, account, it cannot assimilate new, still lost knowledge and skills. Reduces the ability of abstract thinking. Patients find the inability to evaluate adequately the situation and to regulate their conduct. There is no consciousness of the disease. Due to the appearance of suggestibility and weakening moral delays patients sometimes commit criminal actions that are printing crudity and frivolity. Thus, at this stage clearly reveals the main clinical symptom of progressive paralysis - diffuse dementia (dementia paralytica). Fluctuations States of consciousness in the form of different degree of clouded often exacerbate the impression of depth of dementia.
In the third, marasmic, stage PP, which occurs in the absence of treatment in 2-3 years after the onset of the disease, there are phenomena deep dementia, drastic sick; they become untidy, they have bedsores.
Described several forms PP Most often there is a simple Dement form. Other forms allocate depending on the prevalence of additional symptoms (delusions of grandeur, epileptiform or apoplectically seizures, excitation, paranoid, damage). Accordingly, there is an expansive and epileptic, agitated, paranoid, depressed form. These forms are not stable and can change during the course of the disease. In addition, there are also some atypical forms: juvenile PP, emerging in connection with congenital syphilis in children and adolescents in clinical dementia; tabarali characterized by the accession of progressive paralysis to tubes; paralysis of Lissauer, differing mainly affecting posterolateral parts of the brain, therefore, have clinical focal symptoms (aphasia, apraxia, agnosia); Korsakov form with gross violations of memory and confabulation. The last two atypical forms are characterized by slow the symptoms of and resistance to therapy. In the postwar years, described malignant current form p.p. with mild specific serological changes; these forms occur in the early stages of syphilis under the influence of additional hazards.

In parallel with the growth of the psychic changes are gradually revealing somatic and neurological disorders - progressive weight loss, nutritional disorders (ulcers, arthropathy, osteoporosis), gipersalivacia, spontaneous fluctuations of body temperature, syphilitic lesions of aorta. One of the early neurological signs is a syndrome of Argyll Robertson (see the Argyll Robertson's syndrome). The pupils are usually severely restricted (miosis). The early symptoms include speech problems of type so-called dysarthria {see). When the letter are also frequent omissions of syllables or words, trembling hand. There is typical for progressive paralysis of the face mask-like appearance, the asymmetry of nasolabial folds. Frequent tablichka symptoms (and not only in cases of troparia) - no patello and Achilles reflexes, and sensory impairment and coordination. Reactions Wasserman, Sachs - Vitebsk and Cana in the blood of almost 100% of the cases, give a positive result.
In the cerebrospinal fluid Wasserman is positive in 100% of cases, there is an increasing number of protein to 1,0 PPT and higher, positive or strongly positive protein reactions (Nonna - Appelt, Pandi, Weichbrodt), lymphocytosis - a few tens of cells in 1 mm3. Curve reaction Lange with progressive paralysis graphically looks for specific percentage points (so-called paralytic) - wave, and in a digital designation - 66655432100. All these serological changes so typical of untreated PP that negative serological data allow to doubt the diagnosis.
Diagnosis and differential diagnosis. Most diagnostic difficulties arise in the early stages of the disease, which, however, differs from neurasthenia rapid progression of all disease symptoms and the presence of euphoria, syndrome of Argyll Robertson, characteristic serological shifts. From psevdomatematicheskoe (most similar to progressive paralysis) forms of syphilis of the brain PP can be distinguished on the basis of signs of deep dementia, characteristic neurological and serological changes faster than the syphilis of the brain, slew all the painful symptoms. Delimitation p.p. from sometimes similar to it on a clinical picture of a brain tumor frontal site possible with detailed clinical examination on the basis of congestive nipples, negative reactions Wasserman, the presence of protein cellular dissociation in the spinal fluid.
Forecast progressive paralysis better at the beginning of treatment in the early period of the disease.
Treatment. With the medical purpose patient instill pathogen tertian malaria. After 10-12 attacks appointed quinine and other antimalarials (see Malaria treatment). Use other pyrogenic funds (2% suspension of sulfur, pirogenal). 2% suspension of sulfur in persikovom oil after heating for 1 hour and stirring slowly injected intramuscularly in the upper, outer quadrant of the buttocks; initial dose of 0.2 ml; further increase the dose of 0.2 to 1 ml or higher (depending on response); in the course of treatment is 10-12 injections at intervals of 2-4 days. Domestic drug pirogenal administered intramuscular injection in the upper, outer quadrant of the buttocks in doses 10-20-30 mcg with a further gradual increase in dose to 80-150 mg. The course of treatment is 8-12 injections at intervals of 2-3 days. The therapeutic effect of 2% suspension of sulfur and pyrogenal less than malariotherapy. After pyrotherapy (in the case of vaccinations malaria - from the middle of its course) have combined specific penicillin treatment, bikinicom, orally as tablets under special schemes (see Syphilis).
Mental and physical condition improves sometimes directly after the course of piraterie, but more often gradually over several months. As a result of successful treatment smoothed mental disorders (including manifestations of dementia), restored personality. It is also possible smoothing and some neurological symptoms. Cerebrospinal fluid and blood sanitize slower (1/2 years 3-4 years). After 1/2 year 1 year after the holding of infectious and specific therapy should conduct control study of spinal fluid and blood. In the absence of any clinical and serological effect should resort to re-pyrogenic therapy, and recommended a change of infection or the use of another pyrogenic funds.
The frequency of a good remission (full rehabilitation for minor personality changes) amounts to 20%. Recovery faulty and incomplete work capacity is celebrated in 30-40% of cases, in others - unstable improvement or no effect.