Beyl's disease is diagnosed in 5% of patients with syphilis. Epidemiology indicates that women are sick twice as much as men. The only source of infection is a person. The frequency of infection depends on the duration of the disease. The pattern of dissemination of the disease is associated with low awareness of the methods of infection and pathology risk factors.

Patients with early syphilis forms from 3 to 5 years are the most contagious. Late forms whose deadlines are more than 5 years old. The main danger of neurosimifilis development in the initial pores the disorder flows asymptomatic. In most cases, this is due to the high resistance to the pale treponime, which leads to the appearance of insisted and L-forms of the causative agent.

Causes of progressive paralysis

The main causes of progressive paralysis are associated with positive reactions to syphilis. Pale Treplema causes the defeat of the shells of the brain. Disorder is developing in 1 of 5% of patients with syphilis, men are more susceptible to the disease. The average age of patients from 30 to 50 years. This confirms the fact that pathology is developing in 10-15 years after infection.

The causes of progressive paralysis can be nonspecific. Card and brain injuries, emotional experiences, stress, reduction of protective properties immune system and untimely treatment of infectious pathologies can also provoke a psychoorganic violation. Very often the true nature of the deviation is set in a psychiatric hospital. That is, the patient may not suspect the presence of syphilis until neurological symptoms appear.

After establishing the cause of paralysis, the patient is directed to a number of specialists, including a venereologist, which conducts additional diagnostic tests. They are needed to determine the stage of disorder and the preparation of a further treatment plan.

Risk factors

Eliminate such factors for the risk of disease development:

• Sex - the most common option of infection. Bacteria penetrates damage to skin cover and through mucous membranes. Infection is possible when contacting a syphilitic gum or solid hinge, that is, when contacting with an open source of infection.
• Hemotransfusion - infection during blood transfusion from an infected donor during surgery or dental manipulations (this risk factor is minimal, since all blood donors and blood preparations are examined on syphilis, and all operating instruments are sterile).
• Transplascent - the disease can be transmitted from a pregnant woman to the child during the hatching or during the generic process. The risk of infection is associated with possible injuries and breaks of the skin and mucous membranes, which are input gates for infection.
• Contact-household - the use of common household items with infected (towels, dishes, underwear, clothing, hygiene objects).
• Professional - this risk factor is present in medical professionals, which are in contact with biological fluids (saliva, blood, sperm). Infectness is possible when opening corpses or objects.

Regardless of the factor provoked the disease, the pathogen of neuralifilis disappears into lymph nodes and is distributed throughout the body with blood flow.

Pathogenesis

The main causative agent of progressive paralysis is bacterium pale treponema. Pathogenesis, that is, the mechanism of development of the disease is most often associated with a sex factor.

The two ways of penetration of bacteria in the brain substance are distinguished:

1. Lymphogenic - pathogenic microorganism penetrates into a human body through mucous membranes or damaged skin. With blood flow, the infection spreads through the body, reacting to it by the development of specific antibodies.
2. Hematogenic - due to the weakening of the blood hematoencephalic barrier, the infection penetrates into the spinal substrate. First, the vessels and shells of the spine and brain are affected. It provokes the beginning of the inflammatory process with the allocation of exudate. Scar changes are formed in the brain tissue.

Over time, the body weakens and ceases to fight with a malicious microorganism, opening access to the parenchyma of the central nervous system. As a rule, this occurs in 5-7 years after the infection of syphilis or at later stages. Bacteria penetrates nervous cells and fibers, causing their pathological changes and symptomatics of neurosophilis.

Symptoms of progressive paralysis

Psycho-organic pathology has a wide variety of clinical manifestations, severe neurological and mental disorders. The symptoms of the progressive paralysis depend on the stage of the disease, while not rarely missing clear boundaries between different forms.

Beel's disease is characterized by a violation of the shape and reactivity of the pupil. The patient suffers from equilibrium disorders with closed eyes in the standing position, loss of sensitivity, progressive dementia.

The disorder is most often manifested at the age of 35-50 years and has undefined neurasthenic complaints. The deployed stage is distinguished by memory and attention disorders. Also observed pathologies in the emotional sphere, frequent mood swings, irritability, quick temper, depression. Muscle spasms may be observed in the limbs and other parts of the body, nonsense and hallucinations.

First signs

After entering pale treponam in the spinal or brain, its active reproduction begins. The first signs are developing gradually and in stadium. Symptoms of the disease is very similar to the signs of acute inflammation of the brain shells, that is, meningitis:

• Strong headaches and dizziness
• Increased intracranial pressure
• Noise in ears
• Digestion disorders

As soon as the infection penetrates into the brain vessels, such symptoms appear:

• Insomnia and migraine attacks
• Reducing tactile sensitivity

At the next stage there is a defeat spinal cordWhat is manifested by such symptoms:

• Violations by the bodies of a small pelvis
• Weakening of the muscles of the lower extremities
• Reduced muscular and articular sensitivity
• Long-hazing wounds on the skin
• The narrowing of eye pupils and the lack of reaction to light
• Violation of coordination of movements
• Painful feelings at the bottom of the back

Due to the long-lasting bacteria in the brain tissues, their gradual destruction occurs. This is manifested by such signs:

• Progressive personality violations
• Weakening of memory and mindset
• Manic and depressive states
• Hallucinations, delusional ideas

In some cases, the disease provokes epileptic seizures and paralysis. Special attention during the diagnosis is given to the absence of a pupil response to light. The nasolabial folds acquire asymmetry, the handwriting changes, tendon reflexes become uneven.

Progressive paralysis of the brain

The main danger of syphilitic infection is the progressive paralysis of the brain. The disease has several stages, each of which is manifested by certain features.

• Immediately after infection, the patient does not experience pronounced pathological symptoms. Gradually worsens the quality of sleep and the concentration of attention is reduced. This is written off on the overall fatigue of the body or problems with the immune system.
• In the second stage there is a damage to the nervous system. This is manifested by such symptoms: an increase in tendon reflexes, non-uniformity of pupils, tension of the occipital region, muscle pain.
• At the next stage, the syphilis of the brain acquires an aggressive course. The patient has a sharply worsen memory, irritability and increased nervousness appears. Risk of brain vessels stroke increases.

Diffuse syphilic meningoencephalitis is characterized by severe neurological and psychopathological disorders. Without treatment, pathology is completed with deep dementia and fatal outcome.

Juvenile progressive paralysis

The rare shape of a congenital syphilis, which occurs during transplacentating infection is a yuventle progressive paralysis. The morphological basis of pathology is cellular anomalies in the location of nerve cells, which bodies the endarterite of the brain vessels.

Pathological condition can manifest itself both in early childhood and at a later age. In early childhood, defects of the structure of the bone apparatus (curvature of the limbs, a saddle nose) can be revealed, a poorly developed musculature, the defeat of the trap-brain nerves. From 7-9, and in some cases, from 13-15 years, neurosofilis quickly progresses, acquiring a dementary form. There is a loss of acquired skills and skills, emotional disorder. In 15-20 years, the disease is characterized by increasing dementia and epileptiform seizures.

Stages

Several stages of pathology are distinguished:

1. Latent - asymptomic stage with pathological changes in cerebrospinal fluid. Developed within 1 year after infection. Neurological disorders are not manifested.
2. Acute - manifests itself in the first 1-2 years after infection. For this stage, such symptoms are characteristic: headaches, nausea and vomiting attacks, fifthly papular rash. Also, pathology from vision, hearing and facial nerves may also be observed. In rare cases, hydrocephalus and stagnation of optic nerves are developing.
3. Meningovascular - can develop 1-5 months after infection, but is most often diagnosed for 5-7 years of illness. Manifested by symptoms of ischemic or hemorrhagic stroke. There is a concentric narrowing of large arteries and a local narrowing / expansion of small arteries. Before the ischemic crisis, the patient complains of frequent headaches, emotional lability, personal disorders.
4. Meningomyelitis - at this stage, the lower spastic parapapapes with impaired function of pelvic organs and deep sensitivity progresses. Pathological symptoms can develop asymmetrically with signs of brown-secarar syndrome.
5. Spinal dry tok - the incubation period of this stage takes from 5 to 50 years, but an average manifests itself 20 years after infection. At this stage, inflammatory infiltration and degeneration of the rear roots and the spinal cord cords are observed. The patient faces sharp shooting pains, a deep sensitivity disorders, neurogenic disorders. Without treatment, these symptoms begin to progress.
6. Paralytic dementia is a stage of progressive paralysis, which develops in 10-20 years after Syphilis infection. The patient suffers from the depressive state, various severity Neurological disorders, reduction of muscle tone, epileptic seizures, hallucinations. It is characterized by persistent progression that does not rarely lead to a fatal outcome.

From the moment of infection to the stage of progressive paralysis takes place at least 8-15 years. The first signs of the disease do not cause anxiety, as similar to the usual depletion of the nervous system. The development of pathology contributes to the auxiliary factors, for example, chronic diseases, alcoholism, drug addiction.

Forms

Several clinical form of neurosimifilisa are isolated:

• Expansive - the manic form is characterized by the state of Euphoria and delusional, meaningless ideas. The patient thinks he is successful and attributes to himself non-existent wealth. The patient considers himself absolutely healthy and satisfied with the find in a psychiatric institution.
• Depressive - Depressed mood in combination with ridiculous hypochondriac delirium.
• Dementant - increasing dementia, the decline in the ability to critically evaluate the environment, express the right judgment and perceive its condition. Mood euphorical, complacent.
• Tabetic - at this stage with a slow and protracted flow, a combination of signs of paralytic dementia and spine dry is observed.
• Assembly - has a malignant flow with severe motor excitation attacks. There is a confusion of consciousness, the rapid decay of the psyche.

All of the above stages and forms may be accompanied by epileptiform seizures, brain strokes with hemiplegia and paresis, arteriosclerosis. Without proper treatmentEach of the forms can cause fatal outcome.

Psycho-organic pathology has several stages of development, each of which is characterized by its symptom. The stages of progressive paralysis are distinguished:

• The initial is the stage of transparabial asthenia. It is characterized by cerebrasthenia, strong headaches, speech and articulation disorders, increased irritability.
• Expanded - paralytic dementia with a progressive decrease in intellectual-mounted qualities and various personal disorders.
• Terminal - total disintegration of mental activity, insanity.

Complications and consequences

Neurosofilis causes severe consequences and complications. Patients face such problems as:

• Disorder of communicative behavior
• Incapacity
• Stroke
• Injuries obtained when falling due to convulsion
• Partare limbs
• Atrophy of the optic nerve

Complications of this pathology can lead to disability. Launched forms are practically not amenable to therapy and threaten with a fatal outcome.

Diagnosis of progressive paralysis

The identification of Beil's disease occurs on the basis of existing neurological disorders and mental disorders. The diagnosis of progressive paralysis consists of a complex of various clinical studies:

• Collecting anamnesis and analysis of patient complaints
• Laboratory tests
• Tool methods
• Differential diagnosis

During the diagnosis of the patient can be sent to a psychoneurological dispensary to observe. According to the results of all studies, the doctor puts the final diagnosis, determines the stage of illness, methods of its treatment. If progressive paralysis is diagnosed in the early stages, it significantly improves the forecast for recovery.

Analyzes

With suspected diffuse syphilitic meningoencephalitis with damage to the shells, vessels and brain substances, laboratory diagnostics are shown. Analyzes are necessary to identify the causative agent of the disease - pale treponam or other deviations. The patient is prescribed such research:

• Vasserman reaction
• Blood tests and liquor
• Tremponem and non-serum and non-serum tests and liquor
• Microreactment of precipitation with a cardiolipin antigen
• Immunofluorescence reaction (reef)
• Immobilization Reaction Treplem (RIT)

The diagnosis of neurosimifilis is confirmed under the positive results of the tests of treponex reactions in the study of blood serum and with immunofluorescence reaction. And also under changes in the cerebrospinal fluid (the vasserman reaction), inflammatory changes in the liquor with cytosis over 20 μl and protein above 0.6g / l.

Instrumental diagnostics

Symptoms characteristic of Bale's disease require a comprehensive study. Instrumental diagnostics is necessary to confirm psychoorganic pathology. The patient is carried out computer and magnetic resonance tomography.

These methods identify nonspecific changes: heart attacks, gum, atrophy, increased contrast brain shells, multifocal lesions of white substance and other. The results of these studies are used in diagnosis differentiation. Also, the patient is directed to the oculist for inspecting the eye bottom, since visual disorders of violated severity are characteristic of the disease.

Differential diagnosis

Early stages of progressive paralysis in their symptoms are similar to many other psychoneurological disorders. Differential diagnosis helps to separate the true disease from other disorders.

Neurosofilis Differentiate with such pathologies:

• Tumor lesions of frontal brain shares
• Pick's disease
• Brain vascular diseases
• Serous Meningitis
• Vasculit
• Sarcoidosis
• Brucellosis
• Borellosis
• Cerebral atherosclerosis
• Malignant forms of hypertension

Despite the pronounced symptoms of the disease, differential diagnosis It is complicated by the fact that various lesions of the brain can give a picture of dementia, which is present at paralytic dementia. A decisive role in diagnostics plays anamnesis, somatic and neurological examination, the results of serological reactions.

Treatment of progressive paralysis

The symptoms of neurosimifilis require careful diagnosis and correctly composed therapy. Treatment of progressive paralysis passes in the hospital. Neurologist, venereologist, psychiatrist deals with treatment. The patient is prescribed combined specific therapy, which consists of medicines (antibiotics, iodine and bismuth drugs) and physiotherapy.

For the treatment of a specific infection of the nervous system, which consists in penetrating the causative agent of syphilis into nervous and brain tissue, can use the pyroterapy method. Under the pyroterapy implies the use of antimalarial preparations. Medicines are injected intramuscularly and intravenously. The incubation period is from 4 to 20 days. Improving the state of the patient is observed in a month.

The effectiveness of therapy is fully dependent on the stage of the disease, the best results show treatment at the first symptoms of pathology. The results are evaluated by the regression of signs of progressive paralysis and improving the indicators of the cerebrospinal fluid. Covering control is carried out within two years every six months. When new neurological symptoms appear, the growth of old or with cytosis in the liquor, re-therapy is shown.

Medicine

The main goal of the treatment of progressive paralysis is the destruction of the bacterium, which caused syphilis. Drugs are prescribed to minimize pathological neurological symptoms and reducing the epidemiological hazard of the patient with respect to healthy. During treatment, techniques are used to destroy the pale treponam, as well as auxiliary drugs and vitamins. The greatest complexity has launched forms of the disease, as they require long therapy and careful selection of drugs.

Scheme of treatment of psychoorganic pathology:

1. Antibiotic drugs. Patients prescribe medications from a group of penicillins, as they have a wide range of action. Inhibit many malicious microorganisms, affecting the walls of their cells.

• Penicillin

Antimicrobial agent of β-lactam antibiotics. Basic active substance 6-aminopenicillary acid. The drug is administered intravenously (intramuscular administration is inefficient), start with high doses of 2-4 million food 6 times a day for 10-14 days. In the first hours after administration, symptoms of acute fever, tachycardia, strong headaches and myalgia may appear, aggravation of neurological pathologies. As a rule, adverse symptoms are regressed within 24 hours. In particularly severe cases, corticosteroids or NSAIDs are used.

• Erythromycin

It is prescribed for contraindications to preparations of penicillin row. Refers to bacteriostatic, representative of macrolides. In its antimicrobial action, it is similar to penicillins. Active in relation to many malicious microorganisms, including the causative agent of Beil's disease. It has several outputs: tablets, capsules, ointment, powder for intravenous and intramuscular injections. Dosage, like the form of release, depends on the stage of the disease and the characteristics of the patient's body. Side effects There are rarely and manifest in the form of nausea, vomiting and disorders of the gastrointestinal tract. For long use Sustainability and allergic reactions are possible. The drug is contraindicated in its intolerance and severe liver disorders.

• Ceftriaxon

Cephalosporin antibiotic third generation with bactericidal properties. Its activity is associated with inhibiting the synthesis of the cell wall of bacteria. It has a wide spectrum of antimicrobial action. It is used intramuscularly and intravenously in dilution with sterile water for injection. Side effects are manifested by digestive systemAllergic reactions are also possible. Medication is contraindicated with increased sensitivity to cephalosporins and penicillins, in the first trimester of pregnancy and during the liver renal failure. In case of overdose, a change in blood pattern is possible. For treatment, symptomatic therapy is shown.

1. Anti-silicate drugs. In the early stages of the disease are used as monotherapy, but they are most often prescribed in a complex with other drugs.

• Bismoverol

It is used for all forms of syphilitic infection. Available in bottles for intramuscular administration. The drug is introduced 1.5 ml 2 times a week, treatment course is 16-20 ml. Side effects appear in the form of increased saliva, inflammation of the gum mucosa, stomatitis. Also possible nerrit trigeny nerve and bismuth nephropathy. The medicine is contraindicated in diseases of the kidneys and liver, sugar diabetes, pathologies from the cardiovascular system.

• Biokhinol

In the treatment of neurosifilis, it is used in a complex with penicillin preparations. Effective for non-specific lesions CNS. Introduced intramuscularly, two-component way. Dosage 3 ml every 4 day, term dose 30-40 ml. The side reactions are manifested in the form of skin dermatitis, damage to the kidneys and stomatitis. It is contraindicated in the disease of the kidneys and liver, high bleeding. It is not assigned to patients with severe tuberculosis and with high sensitivity to quinine.

1. Preparations for eliminating neurological symptoms, improvement of metabolic processes and blood circulation in the brain.

• PiRsetam

The synthesis of dopamine in the brain is enhanced, increases the amount of acetylcholine and the density of cholinoreceptors. Positively affects exchange processes and blood circulation in the brain, stimulates redox reactions, improves regional blood flow. It is used in cerebral-vascular failure, changes in cerebral circulation, during injuries and intoxication of the brain, atherosclerosis and other neurological disorders.

The tool has several forms of release, so suitable for oral and intravenous administration. The dosage and course of treatment depends on the severity of the pathological process. Side effects are manifested in the form of mental excitement, irritability, sleep disorders. Possible disorders from the gearbox, convulsions, tremor limbs. Contraindications are connected with individual intolerance to the components of the means. Not used in diabetes mellitus and acute renal failure.

• Nootropyl

Medicinal from class nootropov. Improves cognitive processes in the brain, affects the CNS (improves neuron metabolism processes, changes the speed of the excitation process, improves microcirculation by stabilizing the rheological properties of blood). Does not possess the vasodilatory action, but improves the characteristics of the brain circulation.

It is used for symptomatic therapy of psychoorganic syndrome. Daily dosage 160 μg / kg body weight (divided by 2-4 reception). Side effects are manifested in the form of increased nervousness, depression, drowsiness, asthenia. Headaches, insomnia, hallucinations, gastrointestinal disorders, raising libido and allergic reactions are possible. Contraindicated in renal failure, hemorrhagic stroke and intolerance of pyrrolidone, piracetam and other components of nootropyl. In case of overdose, there is an increase adverse Reactions, treatment is symptomatic.

• Cavinton

Expands brain vessels, improves blood flow and brain supply with oxygen. Lowering system arterial pressure. It is used in neurological and mental disorders caused by a brain circulation disorder of different etiology. It has several forms of release (tablets, injection solution), which allows you to choose the most appropriate. As a rule, the drug is moved well. Adverse reactions are possible when intravenous administration - hypotension, tachycardia. Not used in violations of the rhythm of heart abbreviations, unstable arterial pressure and low vascular tone. Subcutaneous administration and use with heparin is contraindicated.

The effectiveness of the treatment of progressive paralysis is estimated by the regression or absence of neurological symptoms, normalization of the cerebrospinal fluid. Therapy is carried out under strict medical control with periodic surrender tests to identify the pathogen in the liquor. If the amount of malicious microorganism does not decrease, then higher doses of drugs or the selection of other drugs are shown.

Vitamins

Syphilis brain requires comprehensive treatment. Vitamins are part of the therapy used in all forms and stages of the disease. Consider what useful macro and trace elements necessary for neurosimifilis:

• Vitamins of this group participate in the processes of cellular metabolism, normalize the work of the whole organism. Useful for the nervous system, regulate energy exchange, improve visual functions and synthesize hemoglobin. Vitamins B6 and B12 regulate the work of the nervous system, the red blood cells are synthesized and regenerated, antibodies are created.
• A is represented by three bioorganic compounds from the Retinoid Group (Retinol, Dehydroretinol, Retinal). It has a powerful antioxidant effect, improves the growth and development of all cells, organs and tissues. Participates in the functioning of mucous membranes and skin epithelium. Retinol is part of the visual pigment, which is in the cells of the retina eye. Its enough sufficient vision supports. Improves the condition of hair, gums and teeth. Speaker preventive tool Malignant lesions of the body, regulates the immune system, enhances the synthesis of immunoglobulins (antibodies) of all classes.
• E is a fat soluble connection with antioxidant properties. Prevents the formation of blood clots, improves microcirculation and does not allow blood stagnation. Improves the properties of blood and the functioning of the immune system. Reduces the pressure, expands and strengthens the walls of the vessels, warns anemia and cataract. Supports the normal operation of the nervous system.
• The constructive drugs of iron - to this category contains preparations with 30 or more mg of elementary iron. They are used as a lining and auxiliary means for anemia, pathologies from the CNS, various inflammatory processes, lesions of the gastrointestinal tract, abundant bleeding.
• Glycine - amino acid with antioxidant, neurometabolic and neuroprotective properties. Regulates the metabolism, stimulates the processes of protective braking of the CNS, warns and stops psycho-emotional voltage. It is used for various disorders of the nervous system, sleep disorders, excessive excitability and emotionality, violations of the vegetative system. It is prescribed to patients with ischemic stroke, as well as with encephalopathy of various genes.
• Nicotinic acid - has anti-inflammatory properties, has vasodinating action, improves the work of the gastrointestinal bodies. Reduces blood lipoprotein levels. It is used for diseases of the vessels, brain, neurites of the face nerve, long-lasting ulcers and wounds, infectious and other lesions of the body.

All of the above vitamins are used only on the prescription of the doctor, which determines the necessary dosage and frequency of their application.

Physiotherapeutic treatment

In the later stages of the progressive paralysis, that is, with a dorsal dry shot, physiotherapeutic treatment is shown. The patient is prescribed a massage of the limbs, electrophoresis and gymnastics according to Frankel.

Consider the main medical physiciderations:

• Massage - spend several courses with short and intense sessions. This is necessary to restore the functions of the limbs, as well as as the prevention of complications of psycho-organic pathology.
• Electrophoresis is a method for delivering medicinal components to the body using an electric current. Therapeutic substances penetrate the tissue through swelling and song hardware. Electricity Increases the synthesis of biologically active substances and increases ionic activity in conductive tissues. Neurosimifilis uses the drug of lidase.
• Frencel gymnastics is a system of exercises performed on slow repetition with gradually increasing complexity. Exercises are designed for the treatment and prevention of movement regulation disorders. This technique is based on the activation of the untouched sensory mechanism (vision, touch, hearing), compensating for kinetic losses.

Physiotherapeutic treatment is carried out under medical supervision in sanatorium-medical institutions.

Popular treatment

With diffuse syphilitic meningoencephalitis with the lesion of the shells, vessels and parenchyma of the brain needed timely diagnosis and correctly selected therapy. People's treatment of progressive paralysis is not recommended, as it is ineffective in the fight against the pale tronamed. But despite this, there are a number folk recipesRecommended with neurosimifilis, consider them:

• 500 g aloe grind with meat grinders and mix with 250 ml of liquid honey. Medical agent It must be broken in a dark cool place within 2-3 days. After that, mix it with ½ cup of red wine and again put in a cool place for 1-2 days. The tool can be stored in the refrigerator and take 1 spoon 2-3 times a day.
• Grind 2-3 apples, add a glass of hawthorn and crushed rosehip fruits to them. Add 5-8 shots of chopped garlic and fill all 2 liters of boiling water to the resulting mixture. The tool must be broken within 2-3 hours, after that it should be strain and take 3 times a day after half an hour after eating.
• Grind the head of the bunch and squeeze the juice. Mixion juice with honey in a ratio of 1: 2. The tool must be taken 3-4 times a day 30 minutes before meals.
• 100 g of dry and crushed oats straw filse 500 ml of boiling water and give it to the cooler. As soon as the infusion cools, strain it and take on the ½ cup all day. This medicine has a fascinating effect and tones the body.

Before using unconventional treatment methods, you must consult with the attending physician. This is due to the fact that some recipes may cause adverse reactions that deteriorate the patient's condition and the course of the main disease.

Progressive paralysis (synonym Bale's disease) is organic disease The brain of syphilitic origin, which is determined by the rapid development of dementia (dementia) with neurological symptoms and cachexia. Progressive paralysis is most often developing between the ages of 30 and 55, in 10-15 years after Syphilis infection. Primary symptoms Progressive paralysis, lasting from 1 to 6 months, are manifested by asthenia (see Asthenic syndrome) or. These violations are always combined with a reduction in memory, complaints about headaches, dizziness, lethargy, indifference to close and their duties, irritability. Criticism to its wrong actions, physical and especially mental state absent. In some cases, only the symptoms of total dementia are increasing (see) - the so-called simple, or dementary, form of progressive paralysis. In others, the ongoing months are developing, the longest year, psychosis: depressive with hypochondrial-nihilistic nonsense, manic cells with delirium magnesium (see affective syndromes), states resembling catatonia (see Cattonic syndrome), hallucinatory-delusive paintings. To any of these psychoses arising during the progressive paralysis, always accompany the symptoms of pronounced dementia. The latter give all the delusional statements of patients with absurd character (see also). In the future, the symptoms of psychosis disappear and the growing increases on the fore.

Neurological disorders always exist and manifest themselves with a disartric lubricated speech, the symptom of Argya Robertson (see), gaitness, inaccuracy of movements, decreased or lack of knee and achyllate reflexes, reversible mono- or hemipabs.

Of somatic disorders, especially in emerging cases, the phenomena of cachexia are noted (see), bone fragility, paralysis of sphincter. Vasserman's reaction in blood and is almost always positive; The number of cell elements is increased, the amount of protein is increased. The combination of progressive paralysis and the dorsal dry house (see) is called Taboparalich.

Treatment: Mandatory and urgent room in the hospital, where treatment of malaria and antibiotics is used. With early treatment, recovery is managed.

Progressive paralysis (synonym Bale's disease) is a parenchymal form of neurosimifilis, a later syphilitic brain damage.

Progressive paralysis arises usually in 10-15 years after Syphilis infection, more often in 40-50 years, but more young people are found. In the past, progressive paralysis was a relatively common disease. Since the 30s of the current century, incidence of progressive paralysis both in the USSR and abroad decreases due to the success of the prevention and treatment of syphilis.

Patoloanomatically progressive paralysis is characterized by phenomena of chronic leptheningitis, grain ependatimitis of brain ventricles, inner and outer hydrocephalus, atrophy of cerebral sorus. In the initial stage of progressive paralysis, inflammatory phenomena are noted; Later, dystrophic changes in cerebral tissue are attached.

IN clinical picture Progressive paralysis combines symptoms of psychopathological, neurological and somatic violations. According to the degree of clinical manifestations, three stages can be distinguished during the progressive paralysis: "neurasthenic" (initial), deployed manifestations of the disease and marantic.

In the initial stage of the progressive paralysis in the foreground, the so-called neurasthenic phenomena in the form of increased fatigue, irritability, reduction of working capacity, headaches are noted. The second stage comes in a few weeks or months. It is characterized by deeper identity changes. The beneficial or unmotivated mood change from euphoria to the outbreaks of irritability or the reaction is weaker. It is often observed with ridiculous delusional ideas of greatness: patients consider themselves the owners of tremendous money, irrelevant treasures, lords of the world, etc. less often marked the depressed mood. The peculiar flaws of the person, which is characterized by a loss of a sense of tact in communicating with people, violation of social and personal connections. Patients make a commemable shopping, spend money, not believing with the material possibilities of the family. Gradually increasing memory violations, accounts, it becomes impossible to absorb the new, the previous knowledge and skills are lost. The possibility of abstract thinking is reduced. Patients detect the inability to evaluate the situation sufficiently and regulate their behavior. There is no mind a disease. Due to the appearance of the suggestibility and weakening of moral delays, patients sometimes commit criminal actions that are protected by immunity and frivolity. Thus, in this stage, the main clinical symptom Progressive paralysis - diffuse dementia (Dementia Paralytica). The vibrations of the state of consciousness in the form of varying degrees of stupidity often aggravate the impression of the depths of dementia.

In the third, marantic, stage of progressive paralysis, which occurs in the absence of treatment 2-3 years after the start of the disease, there are phenomena of deep dementia, sharp depletion of patients; They become untidy, they have breakdowns.

Several forms of progressive paralysis are described. Most often marked a simple dementary form. Other forms are isolated depending on the predominance of additional symptoms (delusions of magnifies, epileptiform or apoplemic seizures, excitation, prosecution, damage). Accordingly, it is isolated on an expansive, enclosable, agitated, paranoid, depressive form. These forms are not stable and can change during the disease. In addition, some atypical forms are also observed: juvenile progressive paralysis, developing in connection with congenital syphilis in children and adolescents under the clinical picture of dementia; Taboparalini, characterized by the addition of progressive paralysis to Tabes; paralysis of Lisouere, characterized by the prevail of the posterior brain's posterior departments, respectively, which there are clinical focal symptoms (aphasias, aprages, agnosy); Corsakovskaya form with rude memory violations and confabulation. The last two atypical forms are characterized by a slow increase in symptoms and resistance to therapy. In the postwar years, malignantly current forms of progressive paralysis with weakly pronounced specific serological changes; These forms arise in the early stages of syphilis under the influence of additional harm.

In parallel with the growing mental changes, somatic and neurological disorders are gradually identified - progressive weight loss, trophic disorders (ulcers, arthropathy, osteoporosis), hypersiviation, spontaneous fluctuations in body temperature, syphilitic aortic lesion. One of the early neurological signs is Argail Robertson syndrome (see Argail Robertson Syndrome). Pupils are usually sharply narrowed (MIOS). Early symptoms include violations of the type of so-called dysarthria (see). With the letter, frequent slips of syllables or words, trembling handwriting, are noted. Characteristic of the progressive paralysis of the face of the face, asymmetry of nasolabial folds, is observed. We often have Tabetic symptoms (and not only in cases of tables) - the absence of paetellular and agchylla reflexes, sensitivity disorders and coordination of movements. The reactions of Wasserman, Zaksa - Vitebsk and Kana in the blood almost 100% of cases give a positive result.

In the spinal fluid, the vasserman reaction turns out to be positive in 100% of cases, an increase in the amount of protein is noted to 1.0 and above, positive or sharply positive protein reactions (nonnet - applet, Pandy, Vechbrodt), cytosis - several tens of cells in 1 mm 3. Lange's reaction curve with progressive paralysis graphically has the form of a specific progressive paralysis (so-called paralytic) teeth, and in digital designation - 66655432100. All these serological changes are so typical for the untreated progressive paralysis that negative serological data allow you to doubt this diagnosis.

Diagnosis and differential diagnosis. The greatest diagnostic difficulties arise at an early stage of the disease, which nonetheless distinguishes from neurasthenia the rapid progression of all painful manifestations and the presence of Euphoria, Argya Robertson syndrome, characteristic serological shifts. From the pseudo-paralytic (most similar progressive paralysis) forms of the syphilis of the brain, progressive paralysis can be degraded on the basis of signs of deep dementia, characteristic neurological and serological changes, faster than during the syphilis of the brain, the increase in all painful manifestations. The deliberation of the progressive paralysis from the sometimes similar to it along the clinical picture of the brain tumor of the frontal localization is possible with a detailed clinical examination on the basis of stagnant nipples, the negative reaction of the Wasserman, the presence of protein-cell dissociation in the spinal fluid.

The forecast of progressive paralysis is better at the beginning of treatment in the early period of the disease.

Treatment. FROM therapeutic goal The patient vaccinates the pathogen of three-day malaria. After 10-12 attacks, Kinein and other antimalarial means are prescribed (see malaria, treatment). Other pyrogenic agents are used (2% silence of sulfur, pyrogenal). 2% Sulfur suspension in peach oil after heating for 1 hour and stinging is slowly injected intramuscularly in the upper-outer quadrant of the buttocks; initial dose 0.2 ml; In the future, the dose is raised by 0.2 to 1 ml and higher (depending on the reaction); The course of treatment is carried out 10-12 injections at intervals in 2-4 days. Domestic drug The pyrogenal is prescribed in the form of intramuscular injections in the upper-outer quadrant buttocks in doses of 10-20-30 μg with a further gradual increase in the dose to 80-150 μg. Course treatment - 8-12 injections at intervals of 2-3 days. Therapeutic effect 2% of sulfur suspension and pyrohenal less than malariotherapy. After the end of pyroterapy (in cases of malaria vaccinations - from the middle of its course), a combined specific treatment of penicillin, biocynol, novarsenol according to special schemes (see syphilis) is carried out.

Mental and physical condition is sometimes improving immediately after the pyroterapy course, but more often gradually, for several months. As a result of successful treatment, the disorders of the psyche (including manifestations of dementia) are smoothed, the identity is restored. It is also possible to smooth and some neurological symptoms. The spinal fluid and blood is slower (from 1/2 years to 3-4 years). After 1/2 year - 1 year after infectious and specific therapy, a control study should be conducted by the spinal fluid and blood. In the absence of any clinical and serological effect, it is necessary to resort to repeated pyrogenic therapy, and the change of infection or the use of another pyrogenic agent is recommended.

The frequency of good remissions (complete restoration of working capacity with minor identity changes) reaches 20%. Recovery with defect and incomplete disability is observed in 30-40% of cases, in the remaining - unstable improvement or lack of effect.

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 lesions of the brain shells and the brain substance was identified 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 personality changes with the loss of the patient's behavior are more distinctly presented, the tact is lost, the criticism of their behavior is reduced. 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.

IN the period of heyday- In the second stage of the disease - along with increasing dementia, decrease in memory and weakness of the thought process, delusional 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 in the clinical picture of certain 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 against the background of complete indifference or complacent attitude towards the surrounding and ridiculous acts. 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 the phenomena of mental delay, the expansive nonsense detention has been joined later. 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. With a hardware examination, dystrophic changes of all internal organs with polyorgan deficiency.

CSR blood in these cases is always positive. In the cerebrospinal fluid, the reaction of Wasserman and other serological reactions are sharply positive, the reaction of 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 individual 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 there is a bilateral paresis of 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, a sharp weight loss, numerous trophic ulcers, bone fragility, urinary bubble paralysis, breakdown, are drawn.

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

Not only the central nervous system is exposed to destruction, but also the whole body as a whole. Therefore, the symptoms of the progressive paralysis develops from a number of symptoms of mental and somatic. Compared to the syphilis of the brain, progressive paralysis has a longer period of time from the moment of infection until the first signs of illness appear, usually five to ten years. This gives the right to call it late syphilitic psychosis. The frequency of the appearance of progressive paralysis in persons undergoing syphilis is from 2 to 4% (according to old authors). In recent years, this percentage has decreased significantly in the Soviet Union, due to the active treatment of syphilis.

Progressive paralysis belongs to the most famous and precisely described mental diseases. This form was allocated from other psychosis in the 1930s of the XIX century on the basis of the study of the course of the disease and post-mortem changes found in the brain of paralytics.

After in 1906, a reaction to the syphilis in the blood and the spinal fluid was opened, and then in 1913 there was a way to detect syphilitic spirochetes in the brain of paralytics, all doubts about the causes of progressive paralysis were eliminated. It became clear that progressive paralysis is a special syphilitic brain disease.

Symptoms and the course of the disease. The picture of mental changes in progressive paralysis is inconspicuous. The first signs of the disease are very similar to neurasthenia: patients discover disability, insomnia, increased irritability, scattered, complain of headaches, fatigue, weakness. Already in the neurasthenic stage of the progressive paralysis, changes in the nature of patients are noted, the mood instability that goes beyond simple irritability.

Soon the first harbingers of the decline in criticism and weakness of judgment appear. Patients cease to notice the advancing changes, in their behavior there are incorrect, incorporated acts. Gradually, the disorders of memory are joined to this, understanding is reduced, patients become stupid, frivolous. Critics defects achieve such an extent that patients are intolerant no longer in the family or in society. They commit immoral actions, stick with sexual logs to women, for children, make unnecessary purchases, etc. In the mood of patients, then the excitement increases, then oppression with the complete absence of the consciousness of his illness.

The weakness of the intellect quickly progresses, patients do not cope with the simplest tasks, can not fulfill the usual action, to wear a suit, button to fasten the buttons, etc. They go sloppy, started, pickled, show constability and dementia, Easily succumb to bad effects, easily cry and are also easy to laugh. Against the background of such a mental decline, paralytic people often appear ridiculous delusional ideas of greatness. Patients talk about their innumerable riches, huge abilities, great strength, about their activities spreading to the whole world. Of all these manifestations of the cloak of the psyche - weakness of judgments, reduce criticism, weak, suggestion - develops paralytic dementia.

From physical symptoms, with progressive paralysis, it is too early for a mask person, due to the immunity of facial expressions, the loss of dexterity and flexibility of movements, the trembling of the eyelids, language and arms. Important signs of progressive paralysis are: no reactions of pupils for light and lubricated speech (dysarthria) With the passing of syllables and individual consonant letters. The same can be seen in the letter of paralytics (trembling, skipping, repetition).

The course of progressive paralysis is often complicated by convulsive seizures, after which there are short-term paralysis and paresis (incomplete paralysis).

In the blood and the spinal fluid from the very beginning of the disease, a positive reaction to syphilis is found, which always helps in the diagnosis of the disease.

Clinical forms. Depending on the predominance of certain symptoms, in the picture of the progressive paralysis there are several of the most typical forms. Most often occur simple dementant form. The phenomena of dementia with it are expressed most clearly. Patients are non-critical, weakly, violations of memory have sharply expressed, the speech of patients becomes increasingly incomprehensible, helplessness and uncertainty. The flow of this form can be slow and long. Less often there was a classic expansive or manic formprogressive paralysis. It proceeds with cheerful, euphorical excitement and delusional ideas of greatness, wealth, power. The expansive form of paralysis will often give independent remissions (improvements).

Next depressive form of progressive paralysis It is rare. It begins with depressive and hypochondriac ideas associated with the motives of self-evidence, sinfulness, fear of illness.

Finally mention junior shape Progressive paralysis, developing on the soil of congenital syphilis, at a young age.

The untreated progressive paralysis in most cases is relatively fast (for two or three years) gives rise to severe dementia, as well as general physical exhaustion, which leads to a deadly outcome. Organs and fabrics paralytic are subject to change: the skin is made by vane, exposed to non-heard and breakdown, bones are fragile, brittle. In the last stage of the disease occur total weakness, the collapse of speech, the inability to stay on the legs, complete helplessness, causing patients to bed.

Under influence treatment Patients primarily comes physical improvement: they are correct, arrive in weight, their muscle strength is strengthened, trembling, weakness, headaches disappear. Mentally, they become calmer, focusing, more serious. They restore memory, attention, the delusional ideas and the unevenness of the mood disappear, an interest in life appears, disability is returned.

Depending on the degree of recovery, it is customary to distinguish full recovery (such cases are relatively rare) improvement with defect and mainly physical improvement.

Progressive paralysis (sin. Bale's disease) is considered a rather rare form of a brain syphilis, since it is diagnosed on average in 5% of people who have undergone such a disease. It is noteworthy that most often from such a notem suffer from male representatives.

The disease begins not immediately after Syphilis infection - on average, it takes 10-15 years. The main pathogen of such pathology is a pale treponema from the primary hearth, that is, from the genital organs, which extends throughout the body.

The clinical picture includes a large number of signs, including:

• strongest headaches;
• noise in ears;
• violation of food digestion processes;
• insomnia;
• muscle weakness;
• problems with coordination of movements;
• hallucinations.

To set the correct diagnosis, it is necessary to comprehensively examine the body. This means that the diagnosis will consist not only of laboratory and instrumental research, but also from events performed directly by the clinician.

The treatment is carried out only conservative and lies in a long reception of antibacterial agents. The forecast directly depends on the stage of occurring the disease and the time of the beginning of specific therapy.

Etiology

The disease is provoked by a pale treponable, which acts as a causative agent. Such a microorganism from the primary hearth is introduced into nervous system And there is a destructive impact on it. In extremely rare cases, it reaches a brain. Against the background of what, in fact, progressive paralysis develops.

Such a disease has some features: it affects only a parenchyma (the main substance of the brain) and does not apply to the shell or vascular formations that surround this body.

There are several paths of penetration of the pathogenic bacteria in the brain:

• lymphogenic - the introduction occurs through the human body, namely through damaged mucous membranes or skin cover. Infection spreads with blood flow;
• hematogenian - in such situations, infiltration of the pathogen is carried out in spinal fluid. Against this background, the pathological process is involved not only the head, but also the spinal cord.

The main risk group is the faces of working age, namely from 30 to 50 years. It is noteworthy that the ailments are not developing immediately after Syphilis infection. This is determined by the fact that only with time human body It ceases to fight a pathogenic bacterium.

Classification

Progressive paralysis in its clinical picture has several progression stages, each of which has its own specific symptoms. Progressing stages are:

• initial stage or;
• deployed stage or pronounced dementia;
• terminal stage or insanity.

There are also several forms of illness:

• expansive - the emergence of manic symptoms, euphoria and meaningless ideas. A person considers himself completely healthy, moreover - he is pleased with what is in a psychiatric institution;
• depressive - depressed mood in combination with ridiculous hypochondriac delirium;
• dementant - the rise of dementia, the mood in patients at the same time is fun and complacent;
• tabetic - the attachment of the signs of spine dry to the symptoms of paralytic dementia;
• assembly - malignant current. A person is pronounced by the confusion of consciousness and quickly develops the decay of the psyche.

Such pathology also includes such stages:

• latent - begins to develop a year after infection. In this case, any specific clinical manifestations are absent. Headache and dizziness may occur;
• acute - manifests itself on average after 2 years and has non-specific symptoms, among which nausea and vomiting, a slight decrease in hearing acuteness and vision;
• meningovascular - diagnosed on the course of the flow. Complaints from personal impairment and emotional instability;
• meningomyelitis - there is a violation of the functioning of the organs of the small pelvis and the lower extremities, problems with sensitivity appear;
• spinal dry tok - often expressed in 20 years of the course of illness. There is a presence of neurogenic disorders;
• paralytic dementia - begins to develop after 10-20 years from the moment of infection with syphilis. Different with sharp progression, which is why it often leads to a fatal outcome.

Children and juvenile progressive paralysis also stands out - it is extremely rare in persons from 6 to 16 years. In the overwhelming majority situations act as a rare form of congenital syphilis.

Symptomatics

The clinical picture of such a disease will progress along with the severity of its flow. So, at the initial stages of development are present:

• sleep disorders - here should include insomnia or drowsiness during the daytime;
• unfortunate irritability;
• chronic fatigue;
• constant weakness;
• strongest headaches;
• reduction of working capacity - due to the fact that a person cannot fully fulfill his duties, he is forced to change the work on the easiest;
• frequent mood change - often the rudeness and arrogance come to the fore;
• reducing visual acuity.

At the stage, dementia arise:

• strong memory violations;
• loss of simple skills;
• inability to learn loved ones and friends;
• loss of criticality to the surrounding events;
• the inability to analyze what is happening;
• disorientation;
• lack of initiative;
• increased anxiety;
• personal changes;
• psycho-emotional excitement.

In later stages, join:

• clouding consciousness;
• violation of speech function;
• loss of ability to count;
• muscle weakness in the upper and lower limbsas well as in other parts of the body;
• loss of short-term memory;
• nonsense and hallucinations;
• capriciousness and hot temper;
• convulsive seizures;
• change in the size and reactivity of the pupil;
• weakness and general exhaustion - for this reason, a person is forced to be constantly in bed;
• paresis and paralysis;
• attacks of loss of consciousness.

When ignoring such symptoms is developing deep dementia, largely increases the likelihood of death.

Diagnostics

This pathology is expressed in a large number of rather specific external manifestations, namely mental disorders. In order to deliver the correct diagnosis, you must implement wide spectrum diagnostic events. First of all, the clinician needs to personally perform several manipulations, among which:

• study of the history of the disease to confirm the fact of infection with syphilis;
• collecting and analyzing life anamnesis;
• assessment of the state of pupils and visual acuity;
• neurological examination;
• a detailed survey of patient or its relatives to establish the first time of the occurrence and degree of severity of characteristic symptoms.

Laboratory studies in this case are presented:

• general blood analysis;
• microscopic study of cerebrospinal fluid;
• blood biochemistry;
• specific serum tests;
• blood tests on syphilis reef and rit.

Concerning instrumental diagnosticsthen it is limited by implementation:

• CT and MRI head;
• lumbal puncture is needed to obtain a liquor;
• procedures aimed at studying the conductivity of nerves.

Such a disease must be differentiated from:

• tumor lesions or vascular brain pathologies;
• serous;
• cerebral;
• malignant forms.

Treatment

Relocation from such a disease is carried out only by conservative methods. Treatment is based on long-term admission of antibacterial substances, 8 courses of such drugs are prescribed to patients. Often, such a technique is complemented by Biokhinol.

Previously, three-day malaria vaccinations were widely used in the therapy, which were aimed at improving temperature indicators. This was due to the fact that only so it was possible to achieve the death of pale treponam.

To date, such substances such as Sulfozin and Pirohenal are used for this. Also patients can be spelled out:

• vitamin complexes;
• a nicotinic acid;
• amino acids with antioxidant, neurometabolic and neuroprotective properties;
• gland preparations;
• lightening substances.

In addition, treatment may include:

• massage limbs;
• electrophoresis and other physiotherapeutic procedures;
• frencel gymnastics;
• homeopathy;
• folk remedies Medicine.

Operable therapy in the treatment of such a disease is not used.

Possible complications

If a person or his relatives will ignore the clinical manifestations of the disease and abandon qualified assistance, the likelihood of the following complications does not exclude the likelihood of the following complications:

• complete loss of skills;
• incapacity;
• violations of communicative behavior;
• extreme degree of exhaustion;
• injuries obtained due to loss of consciousness.

Prevention and forecast

Since progressive paralysis is one of the forms of syphilis, the prevention will first of all be aimed at preventing the emergence of this alend.

Thus, preventive measures include:

• avoiding random sexual relations;
• occupation only by protected sex;
• compliance with the rules of personal and intimate hygiene;
• refusal to use the objects of life in conjunction with a person sick syphilis;
• regular preventive examinations in medical institution With a mandatory visit to all clinicians, including the neurologist.

The forecast of the disease is generally unfavorable - only every fifth patient can achieve complete remission. In 30% of situations, recovery will be accompanied by minor mental manifestations. In other cases, even specific treatment is ineffective, the above complications are developing, resulting in disabilities and fatal outcome.

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