Progressive paralysis - stage, symptoms and treatment of pathology. Progressive Palsy: Description Disease Bale's disease

Progressive paralysis, or bale's disease - a psycho-organic disease of the luethic genesis, characterized by a progressive impairment of mental activities with the formation of a persistent defect, up to dementia in combination with neurological and somatic disorders. For the first time was described by the French psychiatrist Antoine Laurent Beil in 1822. The term "progressive paralysis" was proposed by Delane. For the first time the possibility of syphilitic defeat brain shells And the brain substances were revealed by Lalleman in 1834 at the opening of the patient deceased from syphilis. The proof of the syphilitic nature of the disease was the discovery of pale treponam in the cerebral core of patients with progressive paralysis Pyatnitsky in 1911 and Japanese scientists in 1913. Progressive paralysis arises in adulthood (30-50 years), ≈ twice as often in men, and more malignant than the syphilis of the brain, leading to severe little consequences.

During the progressive paralysis, three stages are distinguished: initial, the stage of development of the disease and the stage of dementia.

Initial stage, like during the syphilis of the brain, is called neurasthenic Stages, or stages of harbing, and is characterized by the appearance of fast fatigue and fatigue, in general muscle weakness, increased irritability imposing apathy. Over time, the identity changes with the loss of the patient are more distinct ethical norms Behaviors are lost, the feeling of smallestness, criticism is reduced to their behavior. To this period include the increase in drowsiness during the daytime and the appearance of insomnia at night; Patients lose their appetite or they appear excessive voraciousness. Against the background of signs of neurasthenia, the most typical for the progressive paralysis of the symptoms is found - the loss of care about the family, the disappearance of sensitivity to loved ones, wastefulness, sludge, loss of smallestness, involuntary, inappropriate use of obscene, cynical, obscene expressions with complete loss of criticism. Subsequently, lethargy is quickly joined and increasing, insurgent to surrounding with weak, sentimentality, passivity (there was a point of view that all these disorders are associated with affective violations). In the future, the dischargeability fall increases: patients in their usual work begin to make gross mistakes, which over time cease to notice due to loss of attention and criticality.

In Neurostatus at this stage, the transient non-uniformity of pupils, the paresis of the eye muscles, tremor, the unevenness of tendon reflexes, the discoordination of movements, the insecurity of the gait is found. Speech becomes monotonous, inhibited or, on the contrary, unreasonably hurried.

In the blood, the Vasserman reaction is more often weakly alone or negative. In the study of the WASSERMAN reaction, the non-older reaction, the Pandy is converted, cytosis (20 - 30 cells) are detected, an increase in protein content. Rit and reef in all dilutions are sharply positive.

AT the period of heyday- in the second stage of the disease - along with increasing dementia, reduced memory and weakness thinking process Crazy ideas arise, improving the mood with gross sexual lesibility. There is no criticism for the state of such patients. Sometimes depression is developing with suicidal tendencies, nihilistic nonsense. According to a predominance in the clinic of the second stage of one or another psychopathological symptoms allocated

Forms of progressive paralysis .

Each of them is distinguished by the predominance of clinical picture These or other disorders from those described above. Many forms of progressive paralysis are development phases Diseases, reflecting along with the depth of the defeat of mental activity at the moment of the painful process and denoting the pace of its development.

Simple, or dementant, The form is up to 70% of cases of progressive paralysis at present. It is characterized by the gradual increase in paralytic dementia with the carelessness, the loss of the tact and the highest ethical norms of behavior, critics, indifference and indifference to the surrounding, reduced memory, show signs of mental failure. Acquisition of new skills becomes impossible. These disorders appear on the background full indifference or complacent attitude towards the surrounding and ridiculous actions. The patient is bought at once four umbrellas, not focusing in their city. The patient brings two kilograms in his pockets. Another patient, a cook, pours Kerosene to Salad, adds sugar to soup. Sometimes easy excitement appears. Patients get up at night, stood ridiculous walks, allow hedonic excesses, not paying attention to traditions and customs. However, professional skills in this form persist relatively long. Later joined dizziness, fainting, arise apoplexiform and epileptiform epiphyroids. Apoplemic seizures are accompanied by the development of mono- and hemipreps, speech disorders; Epileptiform differ in ability and often resemble Jackson. Over time, the patient loses the ability to comprehend the easiest things, forgets the current events.

Stationary paralysis It is characterized by a slow course with remissions, which usually occur with the initial therapy.

Expansive (manic) The form is considered classic. It is characterized by a sharp increase in mood with the occurrence against the background of the total demention of ridiculous delusional ideas of greatness. In particular, patients assure that they are the Lords of the Galaxy, the Lords of the Stratosphere, which have millions of wealth, thousands of residential rooms and cars, which does not prevent them from "shooting" cigarettes from the chamber's neighbors. Against the background of euphoric mood, they can occur episodically, short-term flashes of anger, which change the "royal" complacency. Inadequate situation becomes behavior when patients make frivolous, often ridiculous acts; Show a tendency to ambiguous flat jokes. Not only doctors, but also the patient surrounding the grace, euphoria, carelessness, unjustified joy, as a rule, accompanied by ridiculous delusions of grandeur and wealth (he may be unstable). The clinic of expansive paralysis is characteristic so that in society it was customary to correlate nonsense with global buildings - Megalomania - specifically with progressive paralysis. "Listen, Garin, and you did not have syphilis?" - asks Shelga Engineer Garina, describing his grand ideas in the novel by A. Tolstoy. Sick Guy de Maupassan, already staying on the verge of poverty, claimed that he received an inheritance from Rothschilds, that he was the richest man in the world, at the same time not shy to ask for food. As E. Blair writes, "... the patient is not just God, he is the Supreme God, ships, the size of each with the Lake Geneva, is carrying thousands of millions of millions of diamonds from India ... He invents a bike on which it is possible to drive around the globe around three minutes."

For depressive form There is a decrease in the background of the mood, tears, hypochondriad statements, ridiculous delusional self-evidence ideas are also megamastea. Patients accuse themselves in misconduct, leading to the death of the earth, the whole universe. Sometimes a depressive-ipochondria form with a predominance of a hypochondriatic nonsense with coar syndrome on the background of low mood with tearfulness is distinguished. Depression, longing can lead patient to suicide.

Circular shape Combines two previous and manifests change of manic and depressive states. In mania, paying attention to the euphoric tint and inactive, in depressions - a sullen-gloomy mood, replacing the dysphoria. It is considered characteristic of cyclotimics.

Mounted form It is characterized by sharply pronounced motor excitations with a tendency to destructive trends, aggression, visual and auditory hallucinations and illusions. The speech is incoherent, consciousness is praised by type of twilight. Patients scream, break things, waving their hands, jump, undress, pronounce cynical phrases. Later join the convulsive movements, grinding with teeth, and, later, the death relief. With this form, the exhaustion occurs within a few weeks, with the next seizure there comes death. In less severe cases, the disease in this form stretches for months.

Galoping form It has an extremely unfavorable rapid flow and is accompanied by severely pronounced motor excitations, incoherent nonsense, epileptiform or, less often, apopleptiform seizures, vegetative and trophic disorders, increasing exhaustion and fatal outcome. With the predominance of seizures sometimes allocate epileptiform Palsy, as a rule, flowing unfavorable. "A solid baker is somewhat frivolous about 52 years, lost a decent state on speculation and inventions. One day, suddenly became restless, began to run out of the house, although each time I found some reason to this - I didn't want to tram my oven and so on. A few months later, a hallucinatory attack was suddenly occurring; The voices were ordered to undress donaga, eat only three throats, cut off three fingers. The clinic does the opposite on the contrary, pours soup from the plate in the pelvis and from the pelvic to the plate until everything falls to the floor; It knocks on the door day and night, tears things, jumps, trying to beat the staff, does not recognize the surroundings. Fixing his attention fails. It's completely confused. In addition, the patient has neurological symptoms of progressive paralysis. After 8 days the patient is completely depleted and it is possible to keep it in bed (first with sleeping pills), although he is still fussy. Then moves are made powerless and disorderly; After 8 days, he dies from exhaustion. " (by E. Bleiler) These forms are more characteristic, mainly for persons of an excitable circle.

Hallucinatorium-paranoid The form consists of true and (more) pseudogalucinations, low-powerful ridiculous perception ideas - persecution, impact; catatonic disorders. Arrives people with schizoid features.

Katatonic The form is characterized by the development of a catatonic stupor or excitation. Prognostically unfavorable.

Senile progressive paralysis It develops in persons over 60 years and is distinguished by a long (up to 40 years) latent period. The painting of the disease in these cases is quite difficult to distinguish from the senile dementia. The development of Corsakovsky syndrome with increasing memory disorders, correlations and delirium magnitude is possible.

In cases where focal symptoms are prevailing, characteristic of the preferential localization of the process in the rear sections of the brain - apraxia, agnosia and other similar symptoms with slow progression of dementia - allocate paralysis of Lisouera.

For congenital Syphilis can develop children's and juvenile paralysis. It is often preceded by a delay phenomena mental DevelopmentLater, the expansive nonsense infantal content is joined. The presence of pathognomonic for Lues Congenita somatic signs - saber-shaped legs, luethic aortitis, the hetchinson triad, including parenchymal kerats, labyrinthitis with deafness and getchinson teeth are central upper incisors, having a barrel shape, narrowed to the cutting edge, with a characteristic concreteness of it and slightly deployed inside .

Taboparalich It is a combination of progressive paralysis with a spinal dry shot. In this case, in addition to the symptoms inherent in progressive paralysis, the symptoms of the Tabes are developing - the complete disappearance of the knee and achyllated reflexes, the disruption of sensitivity, etc. is less likely to be depressed with nihilistic nonsense achieving the degree of coat syndrome. Attention is drawn to a violation of a patient's gait: at first it becomes awkward, in the future sobbed and unstable. Tabetic vegetative-somatic violations are developing, peripheral trophic disorders: some patients lose weight, others will be fulfilled, the trick of the face appears, the turgor changes; Against this background, various intercurrent diseases are easily developed. Complications arise: abscesses, furuncula, increased bone fragility, etc. When hardware examination detected dystrophic changes All internal organs with polyorgan deficiency.

CSR blood in these cases is always positive. In the cerebrospinal fluid, the reaction of Wasserman and others serological reactions sharply positive, reaction Lange paralytic type (665543210).

Mental disorders under progressive paralysis are accompanied by multiple neurological symptoms. One of the early signs are pupil symptoms: a persistent anisocorium with myiosis and strain deformation in combination with the symptom of Argya Robertson - with a weakening or lack of photoreaction while maintaining the reaction to accommodation and convergence, pathognomonic for the Loethic Deviation of the CNS. An important feature is dysarthria: the patient is not able to purely articulate separate phrases; During the pronunciation of the words, he whatever stupid on the syllables. In addition to the dysarthritia there is a logoclonium. It is characterized by repeated repetition of the last syllable in a word, for example "Monet-Ta-Ta-Ta". Often observed bilateral pares facial nerve. In this case, the face of the patient is a mask with a sluggish and meaningless expression, subtle mimic movements disappear at all. Speech vile due to the paralysis of the soft sky. Language is shown insecure, it is noticeable to twitch individual muscle beams. Gradually, dysarthria increases, it becomes more and more vague, lubricated, and then low. The handwriting is frustrated: the lines when writing becomes uneven (then take off up, then falling down), there are letters of letters. The letters of unequal, with corners instead of roundings, they are skipped or by way repeated.

Troops of patients with progressive paralysis are also violated. They have increased bone fragility, hair loss, swelling, the formation of trophic ulcers. Despite excessive appetite, there is a sharp progressive depletion of patients.

Stage Dementia It is characterized by sharply pronounced dementia with a decrease in criticism, the weakening of the judgments and the presence of ridiculous conclusions in combination with the euphoria, by the time of replacing apathy, and then constant aspotion. Patients are completely losing interest in the surrounding, cannot serve themselves, do not answer questions. In rare (at present) cases, insanity is developing with disorders of swallowing act, involuntary urination and defecation.

With a neurological examination, the same disorders are found as in the heyday of the disease, however, they proceed noticeably harder, the seizures occur significantly more often, strokes are developing with subsequent steady paresis, paralegia, aphasia and apraxia, often leading to death. In somatic status draw attention to dramatic weight loss, numerous trophic ulcers, bone fragility, paralysis bladder, breakdown.

The causes of death are intercurrent diseases (pneumonia, sepsis) or a luethic lesion of vital important organs (aortic aneurysm break).

Progressive paralysis or Beil's disease is a pathology that arises as a complication after syphilis. This disease is an organic lesion of one of the most important organs - brain.

Development mechanism

The disease begins not immediately after the infection of syphilis, but after a fairly large period of time (on average after 10-15 years). More often, pathology occurs in men. From the primary focus (genital organs) the disease spreads through the body. In some cases, it affects the brain.

A characteristic feature of the progressive paralysis is that it affects the basic substance of the brain (parenchyma) and does not apply to shells and vascular education surrounding it. This allows you to distinguish the syphilis of the brain and progressive paralysis. Violation of the structure of the body tissue leads to the appearance of a clinical picture of the disease.

It is worth noting that progressive paralysis is not found in all patients with syphilis. Recently, the number of cases of its appearance decreased significantly. This is explained by the fact that pathology is associated with insufficient treatment. primary disease - Syphilis.

Thanks modern medicine With timely therapy of this disease, it is possible to avoid serious complications, including the progressive paralysis.

Stages of the disease

The clinical picture of the disease has three main stages, each of which is characterized by certain psychological symptoms. These include:

1. neurasthenic stage;
2. pronounced dementia;
3. stage Maja.

Consider each of the stages of the disease in more detail.

Stage of neurasthenia

At the initial stages of progressive paralysis, patients have a clinical picture characteristic of neurasthenia. The patient notes the appearance of the following symptoms:

• Sleep disorders (insomnia, daily drowsiness);
• Severe irritability for no reason;
• Rudeness, arrogance;
• Increased fatigue, chronic fatigue;
• Reducing activity (apathy, lethargy).

At this stage of the disease, the first signs of the patient's personality change can be seen. The people surrounding that a person becomes more gross and irritable, primitive attractions acquire great importance for him.

Performance changes: in progression of pathology, the patient becomes more difficult to fulfill its duties. Over time, the person will have to change the work on the easiest.

Dementia

At the stage of dementia, the patient's personality changes even stronger. Initially, it can manifest itself ridiculous, incomprehensible surrounding actions. For example, a patient can buy something that he does not need at all, or make an expensive gift to a completely unfamiliar person.

Many patients have kleptomania, while the patient may not hide to take and try to carry out some product from the store.

An important sign is dementia - a strong violation of memory and loss of the simplest skills. A person cannot solve the simplest arithmetic example or not remember, in which city and what country he is. Often the patient forgets where he lives, loses the keys, money, documents.

A person may not recognize his loved ones and relatives, because he does not remember their faces. Patients lose criticality towards surrounding events, cannot analyze what is happening.

For stage, the following psychiatric symptoms are also characteristic of the following psychiatric symptoms:

1. The appearance of nonsense;
2. Depressive states;
3. Increased anxiety;
4. Psycho-emotional excitement.

Depending on the behavior of the patient, several basic forms of dementia are distinguished:

1. Expansive form. The main manifestation is the "mania of greatness". The patient considers himself an infinitely rich and famous, tells ridiculous stories about gold cars and huge bank accounts. The patient feels Euphoria, satisfied with what is happening, feels like the center of the universe.
2. Demantic form. The patient is constantly in a good mood. To the surrounding it refers complacently and calmly.
3. Depressive shape. Patients appear signs of depression, they accuse themselves in any misdeasure. In some cases, ridiculous nonsense appears that they have already died, they have an incurable disease, etc.
4. Assembly form. With this course, the patient is constantly experiencing psycho-emotional arousal. He constantly wants to do something, run somewhere, tears off his clothes. Often, patients scream meaningless phrases, which they seem to explain the reason for their "hurry".

Thus, in the second stage, a change in the identity of the patient, the defeat of the brain is much more pronounced. In the absence of proper treatment, progressive paralysis can move to the terminal stage, for which even more severe psyche disorders are characteristic.

Stage Mazzma

In the third stage of the disease, the insanity is developing - a condition in which the patient loses the simplest skills. The patient with severe progressive paralysis can not remember how his name is where he lives, does not recognize others. His movements acquire a chaotic character, in many respects they look like children's: the patient pulls everything that sees and can take into hand.

Patients cannot move independently, they have severe weakness and general exhaustion. Therefore, constantly in bed. Due to the fixed lifestyle, accompanied by impaired muscle nutrition, they appear muscle contractures, paresis or paralysis.

Diagnostics

Diagnosis of the disease usually does not cause difficulties. If a patient has symptoms of psychiatric violations in the patient in the presence of a diagnosis of syphilis, then he should consult a neurologist. The paralysis of the brain is characterized by a number of neurological symptoms that can appear in the initial stages of the disease and allow it to be diagnosed.

So, violations of speech almost immediately appear. The patient cannot normally disappear long and complex words, cannot speak the simplest patters when the doctor asks him. Another neurological symptom of the disease is the narrowing of pupils. Sometimes they can be unequal size, which is also a sign of the pathological process.

The reaction of pupils to the light is usually absent, however, accommodation (hovering, focus) is preserved. This combination is called the symptom of Argail Robertson. This feature is an a characteristic symptom Progressive paralysis and allows it to diagnose it on time.

The disease is also characterized by violation of sensitivity. The patient often does not notice the appearance of scratches and abrasion. Another one characteristic sign is a change in handwriting. Letters are twisted, the patient cannot write in one line, the text is rising, then it is lowered.

Confirm the diagnosis is necessary with laboratory studies. Signs of the disease can be detected when analyzing blood and spinal fluid. Based on the data received, the doctor establishes the diagnosis and immediately prescribes the appropriate treatment stage.

Treatment

Progressive syphilitic paralysis is a very serious illness that has long been considered incurable. At the moment there is an effective way of therapy, but it has a strong side effect on the body.

For the treatment of progressive paralysis is used comprehensive therapy. First of all, the patient needs to pass anti -ifying therapy to prevent the progression of the disease. However, one specific treatment will not be enough.

In the therapy of syphilitic paralysis, infectious therapy is used - patient infection by another pathogen in order to activate its immunity and eliminate syphilitic defeat. To do this, the patient introduces a special serum containing malaria plasmasses.

After 1-2 weeks, the patient appears symptoms of malaria. The disease has a flow of frequent attacks. Doctors give the patient to transfer about 10 attacks of malaria, after which it is cured with the help of specific therapy.

At the moment, infectious therapy is the only effective way The treatment of progressive paralysis. It must be carried out as early as possible, since in the initial stages there is more likelihood that the functional activity of the brain will be restored.

Thus, syphilitic paralysis is a serious illness, which is characterized by a combination of psychiatric and neurological symptoms. In order to prevent such a serious complication to prevent the emergence of such a serious complication, it is necessary to undergo anti-silicite therapy. This will help the patient to maintain normal cognitive abilities.

Progressive paralysis (paralytic dementia, Bale's disease) is an organic nature pathology marked by progressive violations in psychological and neurological activities, up to the onset. All processes may be accompanied by somatic and neurological disorders.

The probability of development in a patient progressive paralysis varies from 1 to 5% of all people who have suffered. In addition, the male part of patients suffers from the disease more often - according to statistics 5 times, rather than women. Same incubation period Pathology is 10-15 years from the date of infection.

The reason for the development of this disease is the syphilis. With all this risks can increase in the development of other venereal nature and theology of diseases, such as gonorrhea.

Stages of the flow of pathology

In its course, Bale's disease passes 3 stages, namely:

Clinical forms of progressive paralysis

Each of the presented forms of the disease is marked with its special, clinical form The flow of pathology and it is on this issue that it is worth stopping more detail:

Symptomatics of pathology

The symptoms of progressive paralysis will manifest themselves with such signs:

• and failure in the ability to tie complex words
• patient with a diagnosis of progressive paralysis loses the ability of an elementary account, it has a motivation at times;
• patient consciousness is cloudy;
• - both short-term and long-term it;
• in the upper i. lower limbs There is muscle atrophy and weakness, as well as weakness in other parts of the body;
• attacks of nonsense and hallucinations, increased seizures of irritability and hot-tempered, which are replaced by attacks of depression and capriciousness;
• muscular cramp.

A complex of medical measures

The process of treatment is, for the most part, to the course of taking antibiotics and, accordingly, the fight against the root cause provoked the course of the disease.

Today effective treatment Progressive paralysis using penicillin and containing it preparations. In the case of individual intolerance or allergies to Penicillin - apply ceftriaxone, which is injected intramuscularly or in Vienna for 2-3 weeks. Repeated, control rate of treatment, in the absence of deterioration of the patient's condition, shown once every 1-2 years.

Most often, the course of treatment is undergoing psychiatric hospitalWhen in addition to the course of antibiotics, the course of pyrotearapics, treatment with leeches, as well as drugs that suppress the malaria causative agent are appointed.

In this case, the Kinein or other antimalarial preparations are most often prescribed, as well as compositions, for example, 2% sulfur solutions. In addition, Pyrohenal is prescribed - it is injected with injections, intramuscularly, in the dosage of 10 and to 30 μg., Gradually raising to 80-150 μg. The course of treatment is from 8 to 12 injections with an interval from 1 to 3 days.

After the course of pyroterapy, doctors prescribe a combined course specific in nature and treatment of treatment with using penicillin, biocinol, novarsenol.

After half a year - the year of physicians can assign a course of infectious, as well as specific therapy, as well as a control study of the spinal fluid and blood. In the absence of positive trendy of treatment - doctors recommend changing the infectious course of treatment, using a different pyrogenic drug.

In the absence of timely diagnosis and treatment, the patient develops disability, and also increases the risk of developing other, infectious disease theology. There may be a persistent incapacity, failure in communicability and injury due to falling, convulsions.

Progressive paralysis It is the later syphilitic lesion of the brain. If the syphilis of the brain is primarily affected by vessels and shells, then under progressive paralysis, the substance of the brain (parenchyma) suffers mainly. The disease begins 10-15 years after the infection of syphilis, but sometimes before. There are cases and later principles - after 20 years and more after infection.

Progressive paralysis is usually ill faced faces aged from 35 to 50 years, and sometimes children and adolescents. In these cases, syphilis infection occurs intrauterine or domestic. Men are sick slightly. Progressive paralysis develops in a small number of all sifilis. The development of the disease contributes to the harmfulness that act weaken on the central nervous system (alcohol, brain injuries). It should also be noted that the progressive paralysis is more common among those persons who were not treated enough from syphilis or were not treated completely. Number of cases of disease progressive paralysis. This is primarily the result of the successful fight against syphilis.

The main in the clinical picture of the disease is increasing dementia. The course of progressive paralysis is customary to divide into three stages:

1. neurasthenic
2. larovamy (severe clinical phenomena)
3. mazma

The division at the stage conditionally and depends on the prevalence in the clinic of one or another symptoms.

Neilistrial Stage. it initial stage Progressive paralysis, knowledge of which is very important for timely diagnosis and treatment.

Patients have a dream, appears increased irritability, fatigue, tactlessness, decreases interest in work, primitive attractions begin to prevail. In this stage, there is sometimes a decrease in activity, people energetic in character become sluggish, passive. During the entire period, patients may remain in their former work, especially if it is easy. But with the development of the disease, the patient is increasingly difficult to solve the task arising before him. The further the disease is, the fact of the patient is changing, the picture of organic dementia is growing.

Stage Lyostomiam. In this stage, patients often observed ridiculous acts, testifying to the presence of dementia. Patients can do expensive gifts to unfamiliar people, and at the same time completely cease to take care of their loved ones. Sometimes these worries are expressed in unnecessary purchases. So, one patient for all his savings bought several drawers of triple cologne and brought them as a gift to his wife. Other, receiving wages, I began to go shopping and buy needles for preims. He bought them until he spent all the money. In some, there is a tendency to theft, but due to the presence of dementia, theft is usually ridiculous: the patient can in front of everyone to take some thing with a fit.

In the future, memory is increasingly decreasing, right up to the fact that a person with higher education It cannot solve an easy arithmetic task. Patients disappears a critical assessment of its condition. Sometimes they cannot find their own apartment, cease to recognize their relatives and acquaintances. Against the background of organic dementia, additional symptoms appear - nonsense, depression, excitement. Depending on the prevalence of certain symptoms and allocate various forms Progressive paraditch.

The main place in the clinical picture of the expansive form (classical) is delivered by the magnitations and wealth. A feature of nonsense is his absurdity. The behavior is extremely contrary to the statements of patients. So, for example, the patient stated that he had gold wagons, and at the same time tried to collect residues of food in. Dining room. Patients have euphoria. They are all satisfied, careless. Such patients often produce special costumes, hang on the chest of hardware, paper, stating that this is the signs of differences. One of the patients considered himself a great commander, another, in the past by the specialty engineer, all others assured that he is a mother heroine. The following illness history is indicative.

In cases where in the foreground in the picture of the disease, there is a dementary, combined with the complacency, talking about the dementary form of progressive paralysis.

For depressive form The mood of patients is suppressed. Patients express ridiculous nonsense, declare that they have rotted everything internal organsthat they are already dead. Often accused of calling themselves with unfit people, they assure that they wanted the whole family that because of them everything dies, disappears. The depressive form is rare.

In the clinical picture of an agitated form, excitement prevails. Patients are hard to keep in bed. They jump up, try to run somewhere. Underwear breaks off, shout a set of phrases, among which sometimes you can catch the ideas of greatness. From food, as a rule, refuse or swallow it, without chewing. This form is the most malignant.

With all the forms of progressive paralysis, if not treated for a patient, psychic and physical degradation occurs, which can reach an extreme degree - maratism.

Stage Mazzma. If this stage comes, then the patients lose the simplest skills, as a result of extreme exhaustion and weakness, they all the time are forced to be in bed, they become untidy, they often come to paresis, paralysis. From a long stay in bed and due to trophic violations, they develop contractures, breakdowns, fractures, bones easily arise. The dementia achieves such an extent that the patients cannot call their own: name, they take everything in his mouth that he gets into hand. In this stage, patients usually die from strokes or random diseases that they have easily arise.

Neurological symptoms. To pretty early signs Progressive paralysis includes speech disorders. During a conversation with patients, it can be noted that it is difficult for him to pronounce complex words, patters.

Pupils are often narrowed, unequal values. Their reaction to the light is usually absent, the reaction to convergence and accommodation is preserved. Such a combination is called the symptom of Argail-Robertson. These features are of great importance for timely recognition of progressive paralysis. With progressive paralysis, there is a change in sensitivity in the direction of its decrease. Therefore, patients do not notice, scratches, abrasion, changes handwriting, letters and lines become uneven.

Serological reactions. The Vasserman reaction in the study of the spinal fluid and blood is usually positive. Great importance For the diagnosis of progressive paralysis, a reaction with colloid gold (Lange reaction) has a reaction. In the spinal fluid, the protein content and uniform elements increase.

Pathological anatomy. Progressive paralysis has a characteristic, pathologist. From the side, the brain shells marked their thickening, increment to the brain substance. When the shells are separated from the brain, the pieces of the brain substance are broken together with them. Vessels sclerosy. If you look at the brain surface, the smoothness of the convulsion is attracted; furrows are expanded. Brain ventricles are also expanded, which indicates the presence of inner water. Brain weight decreases. With a microscopic examination of the brain, specific chronic diffuse leptoteningo encephalitis is found.

Etiology. The question of the connection of progressive paralysis with syphilis before the beginning of the 20th century remained controversial. The inextricable connection of syphilis and progressive paralysis became apparent after it turned out that with progressive paralysis, the Vasserman reaction is positive.

The final question about the connection of the progressive paralysis with Syphilis was resolved after discovering the Japanese scientists of the legs (1913) pale spirochetes in the brain.

Prevention. Since progressive paralysis is a syphilitic disease, it is natural that prevention conclude in careful treatment of initial forms of syphilis and its liquidation.

Treatment. One specific treatment with progressive paralysis does not give the desired therapeutic effect. Progressive paralysis was considered an incurable disease until the method of infectious therapy was opened.

The priority in the development of this method of treatment belongs to our compatriot Odessa, A. S. Rosenblum.

He in the 70s of the last century, drawing attention to the fact that mentally ill, including patients with progressive paralysis, sick with returning typhoid, began to recover, specially began to infect such patients with returning typho. Later on the basis of this principle, Wagner Yaurreg began to treat patients with vaccinations three-day malaria. For the same purpose, the contamination of rat tit is used.

Currently, the method of treating malaria has the greatest distribution. Patients become infected with 5-7 ml of blood comprising, malaria plasmas in subcutaney tissue.

After 8-10 days, the patient begins the attacks of malaria. On average, the patient is given to transfer 9-10 attacks. Then the attacks of malaria are stopped by castinpa (or acrycine, bigumal), after which specific therapy is performed.

The effectiveness of treatment depends on how timely the treatment has begun. The earlier malaria or return title was vaccinated, the higher the efficiency.

There are often cases when patients are returned after treatment, work. There is a reason for reason to believe that a good therapeutic result with this form of therapy is due not only to the effectiveness of the temperature (methods of hyperthermia of such a therapeutic effect), but also by those immunobiological-shifts that are observed at. infection with these infections.

Positive therapeutic effect It is observed even in cases where the indicated infections flow without a noticeable increase in temperature.

Care. The greatest difficulties are care for excited and physically weakened patients. If patients have urine delay and need to conduct catheterization, it should be done with great care. It is necessary to remember the decrease in sensitivity in patients with progressive paralysis and that they have very easily developing infections. It is necessary to carefully ensure that lying patients do not form a breakdown.

Therefore, it is important to wipe skin Covers, campaign alcohol and contain patients clean.

When careing for them, we must not forget that many of them have pronounced trophic changes that sometimes appear to be increased bone fragility. Careless handling of patients during its turning into bed can lead to fractures: fractures of ribs are especially easily. If the course of treatment with malaria is appointed, then it is necessary to strictly monitor the temperature and condition of the cardiovascular system, to carry out all the activities in which he needs severely ill with infectious disease.

When feeding patients, it should be borne in mind that they have difficulty swallowing and food can get into the larynx.

Neurosofilis - this is an infectious syphilitic defeat of the central nervous system A person caused by pale trepalous.

The causative agent of Pale Treplema (or pale spirochete), having a spiral structure, as a corkscrew penetrates the skin's microcracks or the human mucosa, falling into blood or lymph, and then into the brain, hitting the nervous system.

Infection is more often occurring at unprotected sexual intercourse with a sore partner, and may occur both and domestic route (through wet towels, dishes), but these cases are rare.

The causes of the development of human neurosimifilis are considered the wrong or late treatment of syphilis, numerous brain injuries, violations immune system, hereditary predisposition and other.

Currently, there is a decrease in neurosofilis cases, it may be due to a decrease in the neurotropy of pale treponam, a change in the pathogenic properties of the causative agent of the disease.

Neurosimifilisa classification

1. Asymptomic neurosimifilis

2. Meningovascular neurosophilis (shells and brain vessels are affected)

• cerebral (meningoencephalitis, cerebral heart attack)
• spinal (meningomyelitis, spinal cord heart attack)

3. Parenchimato neurosimifilis (the tissues of the head or spinal cord are affected)

• progressive paralysis
• taboparalich
• spinal dry tootk
• atrophy of optic nerves

4. Gummime neurosimifilis (the emergence of specific formations - GUMM)

Neurosofilis they divide on asymptomic (hidden), early and late forms. The hidden form proceeds asymptomatic, pathological changes are found only in the patient's spinal cerebral fluid (lymphocytic pleaocytosis, an increase in protein content by 2-3 times due to globulins).

Early neurosophilis occurs during the first 3-5 years after infection (more often in the secondary period of syphilis). Such forms are rare enough, thanks to modern treatment, but they have place. Mental symptoms with early neurosophilice forms are similar to mental symptoms With encephalitis, meningitis, vascular and tumor lesions, syphilitic neurosis, neuritis and polyneurite are found. They are associated with the defeat of the brain shells and vessels.

Late forms of neurosimifilis appear after 5-10-15 years from the beginning of the disease (this is the tertiary period of syphilis), there are cases of occurrence of the disease 20 years after infection. These include: spinal dry tok, syphilitic gum and progressive paralysis.

Progressive paralysis - This is meningoencephalitis (inflammation of shells and brain shells), leading to a violation of cognitive functions (memory, thinking), a change in personality to the total decay of mental activity, or dementia.

This form of neurosifilis is associated with the direct penetration of the causative agent in the cerebral cells and their subsequent destruction. Progressive paralysis arises in men 3-5 times more often than women. The average age of sick - older than 40 years can occur in the old age.

Attention is drawn to the thoughtful, mask patient's face, with a characteristic asymmetry of nasolabial folds, deviation of the tongue to the side, fibrillar twitching of the near-emitting muscles.

One of early symptoms Progressive paralysis is dysarthria. Initially, it appears when pronouncing difficult words, later goes into a fuzzy, vague, chant speech.

In half cases of progressive paralysis, neurological symptoms are characterized: increase or decrease pain sensitivity In the zones of Hitzig (the innervation zone of the first branch trigeny nerve) - region of nipples, navel, groove fold, increase and uneven tendon reflexes, disruption of coordination of movements, tremor, change of hand writing, reduced muscle tone.

Epileptiform attacks occur, sometimes serial. Occasionally, visual disorders - Ardzhilla-Robertson Syndrome: Pupils of the patient acquire an uneven shape and weakly react to light. May be observed psychotic symptoms By type of manic-depressive states, nonsense or hallucinations. Often the combination of progressive paralysis and spinal dry house.

Stages of progressive paralysis

Often the disease begins to be treated, imperceptibly, so patients are asked for help in pronounced stages when the cure is difficult.

1. Initial (neurasthenic) stage.Characterized by complaints headache, irritability, fatigue, sleep disorder, nervousness, reduced performance, and so on. Non-specific neurotic symptoms are often combined with rude emotional disorders of an organic nature: patients become evil, quick-tempered or, on the contrary, indifferent to the surrounding people, lose moral attitudes, shame.

In other cases, there are cases of rapid increasing reduction in intelligence, memory. Patients may seem stunned, inattentive, poorly understand the meaning of read or said, responds to the nefple, suffers from the past and current events. The criticism of their condition is reduced, the level of judgment, unreasonable optimism may be observed. Already at the beginning of the progressive paralysis, psychotic phenomena may be observed: manic-depressive states, katathon-like excitation or stupor, and hypochondriartic disorders.

2. Stage of the deployed disease (paralytic dementia).There is a further loss of individual personal traits with a complete loss of criticism of its condition. Patients are in complacent euphoria or blunt emotional indifference, disbuilding is noted, violation of behavior. Intellectual decline continues until the loss of simplest forms. Neurological and mental disorders described above are found.

3. Original stage (stage of marasma)coming B. different timesOn average after 2-5 years from the beginning of the disease. Full decay of mental activity, physical helplessness, , deep - Signs of emergency patients. Thanks modern methods Treatment, the disease usually does not reach this stage, but remains at the level of paralytic dementia.

Diagnosis of neurosimifilisa

The diagnosis of neurosimifilis can be put on the basis of 3 main criteria:

• clinical picture of the disease
• diagnostic serological samples
• research of the patient's spinal cerebral fluid

The patient must be examined by a neurologist and an oculist to confirm the accompanying neurological and visual disorders. Already on early stages Diseases appear disorders of memory and intelligence, which is confirmed by psychological tests (test "Drawing hours", ).

With the diagnostic goal, serological blood samples or patient lycvore (Vasserman reaction - RW, RPR, IFA, Ribt, RPGA) are carried out.

RPR (Rapid Plazma Reagin - anti-kardolypin test screening unintended test, revealing antibodies (react) IG G G G and Ig M to lipoid and lipoprotein-like material released from damaged cells with syphilis. This test is a modern analog vasserman reactions (RW). In most cases, a positive RPR is a blood reaction is observed 7-10 days after the advent of primary chancra or after 3-5 weeks after infection. The diagnostic value of the sample decreases after the onset of the secondary stage of syphilis. In 30% of patients with late syphilis there is no reaction to RPR sample. Thus, blood research is better revealed by the early forms of syphilis, up to 5 years from the primary infection. To identify the late forms of syphilis, the spinal brain fluid (liquor) is investigated. The positive reaction of Wasserman in the liquor with progressive paralysis reaches 100%.

This test is not specific, since in some autoimmune diseases, sugar diabetes, people who use drugs can be observed false positive results. Therefore, the most faithful will be the simultaneous purpose of RPR - test with ELISA - analysis.

ELISA (immunoferment analysis) relands antibodies Syphilis Ig M and Ig G in patient blood. IFA results allow laboratory to confirm the diagnosis of syphilis from the end of the 3rd week from the moment of infection.

Reaction of immobilization of pale treponam (Ribt) It is the most specific serological test. Starting from the second stage of syphilis, Ribt is positive in all patients. This test also reveals the late form of syphilis, over 5 years from the beginning of infection.

Passive hemagglutination reaction (RPGA) - A test based on the definition of specific antibodies to the pale treponime.

To identify neurosimifilis in the absence of symptoms of the compression of the brain, the patient is carried out with a lumper puncture and a study of the spinal cord fluid. The characteristic features of the liquor are the foundation of pale treponia, lymphocytic pleaocytosis, an increase in protein content over 0.6 g / l).

Using (MRI or CT) indirectly confirms the diagnosis of neurosimifilis, the hydrocephalus is noted, the expansion of subarachnoid spaces, the multifocal lesion of the white matter of the brain, its atrophy, and also serves to eliminate other diseases.

Treatment of neurosofilisa

Currently, penicillinotherapy is used to treat syphilis. Penicillin penetrates well through the hematostephalic barrier, especially when intravenous administration The drug, which allows to achieve a successful patient cure.

Intravenously injected with a sodium salt of benziphenicillin in a dose of 10-12 million units 2 times a day for 14-20 days, then returned.

Penicillin 2-4 million is administered intravenously by 2-4 million. Edition 6 times a day (daily dose of 12-24 million units) for 14-20 days.

In case of intolerance, allergies on penicillin are used to treat Ceftriaxone intramuscularly or intravenously in a daily dose from 1 g to 4 g for 14-20 days.

The first injection of the antibiotic is injected intramuscularly to avoid by-reaction Yarisha-Gersheimer due to the decay of a large number of pale treponam. It manifests itself acute fever, headaches, chills, decline arterial pressure, muscular pain, convulsions. Typically, symptoms are held during the day against the background of the administration of glucocorticoids (60 mg of prednisone) and non-steroidal anti-inflammatory drugs.

The criteria of neurosofilis cure are the coagulation of neurological symptoms and normalization of the patient's liquor. Further control of the spinal fluid is carried out 1 time in 6 months, within 3 years after the diagnosis is set. Persistent normalization of the liquor (even with persistent residual neurological symptoms) - indication for removing from dispensary accounting in a dermatovenerologist.

Video "Neurosofilis"