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General paresis
General paresis of the insane; General paralysis of the insane; Paralytic dementia
General paresis is a problem with mental function due to damage to the brain from untreated syphilis.
Causes
General paresis is one form of neurosyphilis . It usually occurs in people who have had untreated syphilis for many years. Syphilis is bacterial infection that is most often spread through sexual or nonsexual contact. Today, neurosyphilis is very rare.
Neurosyphilis
Neurosyphilis is a bacterial infection of the brain or spinal cord. It usually occurs in people who have had untreated syphilis for many years....
Syphilis
Syphilis is a bacterial infection that is most often spread through sexual contact.
With neurosyphilis, the syphilis bacteria attack the brain and nervous system. General paresis often begins about 10 to 30 years after the syphilis infection.
Symptoms
Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include:
Dementia
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
- Memory problems
- Language problems, such as saying or writing words incorrectly
- Decreased mental function, such as problems thinking and with judgment
- Mood changes
-
Personality changes, such as delusions,
hallucinations
, irritability, inappropriate behavior
Hallucinations
Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.
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Exams and Tests
The doctor will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. Mental function tests will also be done.
Tests that may be ordered to detect syphilis in the body include:
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CSF-VDRL
CSF-VDRL
The CSF-VDRL test is used to help diagnose neurosyphilis. It looks for substances called antibodies, which are sometimes produced by the body in rea...
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FTA-ABS
FTA-ABS
The FTA-ABS test is a blood test to detect antibodies to the bacteria Treponema pallidum, which causes syphilis.
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Tests of the nervous system may include:
-
Head CT scan
and
MRI
Head CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
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A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
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Nerve conduction tests
Nerve conduction tests
Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve.
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Treatment
The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared.
Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred.
Treatment of symptoms is needed for existing nervous system damage.
Outlook (Prognosis)
Without treatment, a person can become disabled. People with late syphilis infections are more likely to get other infections and diseases.
Possible Complications
Complications of this condition include:
- Inability to communicate or interact with others
- Injury due to seizures or falls
- Inability to care for yourself
When to Contact a Medical Professional
Call your health care provider if you know you have been exposed to syphilis or another sexually transmitted infection in the past, and have not been treated.
Call your provider if you have nervous system problems (such as trouble thinking), especially if you know you have been infected with syphilis.
Go to the emergency room or call the local emergency number (such as 911) if you have seizures.
Prevention
Treating primary syphilis and secondary syphilis infections will prevent general paresis.
Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis.
References
Hook EW. Syphilis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 319.
Radolf JD, Tramont EC, Salazar JC. Syphilis ( Treponema pallidum ). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 239.
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Central nervous system - illustration
The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.
Central nervous system
illustration
Review Date: 2/27/2016
Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
