St. Luke's Hospital
Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
Find a Physician Payment Options Locations & Directions
Follow us on: facebook twitter Mobile Email Page Email Page Print Page Print Page Increase Font Size Decrease Font Size Font Size
America's 50 Best Hospitals
Meet the Doctor
Spirit of Women
Community Health Needs Assessment
Home > Health Information

Multimedia Encyclopedia

    Print-Friendly
    Bookmarks

    Syphilitic myelopathy

    Locomotor ataxia

    Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.

    Causes

    Syphilitic myelopathy is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infection. For information on the disease, see: Syphilis.

    The condition called tabes dorsalis includes syphilitic myelopathy and other symptoms of nerve damage.

    The infection damages the spinal cord and peripheral nervous tissue.

    Syphilitic myelopathy is now very rare because syphilis is usually treated early in the disease. Blood tests can identify the disease in its silent (latent) form. People who donate blood and pregnant women are given these tests.

    Symptoms

    • Abnormal sensations (paresthesia), often called "lightning pains"
    • Difficulty walking
    • Loss of coordination
    • Loss of reflexes
    • Muscle weakness
    • Wide-based gait (the person walks with the legs far apart)

    In syphilitic myelopathy, there are also symptoms of nervous system damage, including:

    • Mental illness
    • Stroke
    • Vision changes

    Exams and Tests

    Physical examination may show:

    • Damage to the spinal cord (myelopathy)
    • Pupils that react abnormally to light
    • Reduced or absent reflexes due to nerve damage

    Tests may include the following:

    • CSF (cerebrospinal fluid) examination
    • Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
    • Serum VDRL or serum RPR (used as a screening test for syphilis infection -- if it is positive, one of the following tests will be needed to confirm the diagnosis):
      • FTA-ABS
      • MHA-TP

    Treatment

    The goals of treatment are to cure the infection and slow the progression of the disorder. Treating the infection helps prevent new nerve damage and may reduce symptoms, but it does not reverse existing nerve damage.

    For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may have to be desensitized to penicillin so that they can be safely treated with it.

    Symptoms of existing neurologic damage need to be treated. People who are unable to eat, dress themselves, or take care of themselves may need help. Rehabilitation, physical therapy, and occupational therapy may help people who have muscle weakness.

    You may need analgesics to control pain. These may include over-the-counter medications such as aspirin or acetaminophen for mild pain, or narcotics for more severe pain. Anti-epilepsy drugs such as carbamazepine may help treat lightning pains.

    Outlook (Prognosis)

    Progressive disability is possible if the disorder is left untreated.

    Possible Complications

    • Complications of late-stage syphilis infection, which may include:
      • Inflammation of the aorta (aortitis) with aortic aneurysm
      • Disease of the heart valves
      • Damage to bones, skin, and other organs
    • Complications of neurosyphilis, including dementia, stroke, eye disease
    • Difficulty with walking and balance
    • Paralysis

    When to Contact a Medical Professional

    Call your health care provider if you have:

    • Loss of coordination
    • Loss of muscle strength
    • Loss of sensation

    Prevention

    Proper treatment and follow-up of primary syphilis infections reduces the risk of developing syphilitic myelopathy.

    If you are sexually active, practice safe sex and always use a condom.

    All pregnant women should be screened for syphilis.

    References

    U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: reaffirmation recommendation statement. Ann Fam Med. 2009;150:705-709.

    Tremont EC. Treponema pallidum (syphilis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 238.

    Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR. 2010 Dec 17;59(RR-12):1-110.

    Hook EW III. Syphilis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 327.

    BACK TO TOP

    • Superficial anterior mus...

      illustration

      • Superficial anterior mus...

        illustration

      Tests for Syphilitic myelopathy

        Review Date: 8/15/2012

        Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
        adam.com

        A.D.A.M. content is best viewed in IE9 or above, Fire Fox and chrome browser.


        Back  |  Top
        About Us
        Contact Us
        History
        Mission
        Locations & Directions
        Quality Reports
        Annual Reports
        Honors & Awards
        Community Health Needs
        Assessment

        Newsroom
        Services
        Brain & Spine
        Cancer
        Heart
        Maternity
        Orthopedics
        Pulmonary
        Sleep Medicine
        Urgent Care
        Women's Services
        All Services
        Patients & Visitors
        Locations & Directions
        Find a Physician
        Tour St. Luke's
        Patient & Visitor Information
        Contact Us
        Payment Options
        Financial Assistance
        Send a Card
        Mammogram Appointments
        Health Tools
        My Personal Health
        mystlukes
        Spirit of Women
        Health Information & Tools
        Clinical Trials
        Health Risk Assessments
        Employer Programs -
        Passport to Wellness

        Classes & Events
        Classes & Events
        Spirit of Women
        Donate & Volunteer
        Giving Opportunities
        Volunteer
        Physicians & Employees
        For Physicians
        Remote Access
        Medical Residency Information
        Pharmacy Residency Information
        Physician CPOE Training
        Careers
        Careers
        St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
        Copyright © St. Luke's Hospital Website Terms and Conditions  |  Privacy Policy  |  Patient Notice of Privacy Policies PDF Sitemap St. Luke's Mobile