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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.

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:

  • 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

 

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:

  • CSF-VDRL
  • FTA-ABS

Tests of the nervous system may include:

  • Head CT scan and MRI
  • Nerve conduction tests

 

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.

 
  • Central nervous system

    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

    • Central nervous system

      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

    Self Care

     

      Tests for General paresis

       

       

      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.

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