General paresis
Key points
- General paresis is an impairment of mental function caused by damage to the brain from untreated syphilis.
- General paresis is one form of neurosyphilis, which is a manifestation of a late, untreated syphilis infection.
- Signs and tests An eye examination may indicate a change in pupil response.
- People with late syphilis infections are more prone to the development of other infections and diseases.
Definition
General paresis is an impairment of mental function caused by damage to the brain from untreated syphilis. It is now extremely uncommon.
Causes, incidence, and risk factors
General paresis is one form of neurosyphilis, which is a manifestation of a late, untreated syphilis infection. It is a progressive, life-threatening complication.
The infection causes widespread damage to the nerves of the brain. This damage results in personality changes, mood changes, hyperactive reflexes, eye changes with abnormal pupil response, abnormal mental function including hallucinations and delusions, decreased intellectual functioning, speech changes, and brief, sharp, "lightning" pains that are characteristic of tabes dorsalis.
General paresis typically begins about 15-20 years after the original syphills infection. The risks include previous syphilis infection and previous infection with other sexually transmitted diseases, such as gonorrhea (which may hide symptoms of syphilis infection). Syphilis infections are transmitted primarily through sexual contact with an infected lesion, but may also occasionally be transmitted by non-sexual contact.
Symptoms
- Seizures
- Loss of short-term memory (recent events)
- Loss of long-term memory (long-past events)
- Impaired judgment
- Decreased language ability (aphasia)
- Loss of ability to calculate
- Personality changes
o Inappropriate moods
o No mood exhibited
o Irritable, angry
o Delusions, hallucinations - Decreased motivation, apathy
- Muscle weakness (difficulty using legs, arms, or other parts of the body)
Signs and tests
An eye examination may indicate a change in pupil response. A neurologic and muscular examination indicates slowly progressive dementia, with loss of multiple brain functions. Muscle weakness may be evident. There may be a loss of vibratory and position sense. Gait disturbances are common. The person may be unable to stand with the eyes closed (Romberg test).
Blood tests to detect syphilis in the body include:
- VDRL
- FTA-ABS
Tests to evaluate the nervous system may include:
- A CSF (cerebrospinal fluid) examination with abnormal results (positive VDRL or FTA-ABS test of CSF confirming neurosyphilis)
Written and revised by
Andrey Nailor, M.D.
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