Tabes dorsalis (patient information)

# Overview
Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue. Most symptoms of tabes dorsalis include, lightning pains, impaired sensation and proprioception, hypesthesias, progressive sensory ataxia(inability to feel the lower limbs), diminished reflexes or loss of reflexes, Poor coordination or loss of coordinatio, Unsteady gait(locomotor ataxia) and Sexual function problems. patients with tabes dorsalis has abnormal VDRL and RPR test result and the diagnosis should be confirmed by some other special tests. Penicillin is the treatment of choice for tabes dorsalis that kills all treponema pallidum bacteria but sever spinal damage may be permanent. Common complications of tabes dorsalis include; Dementia, stroke, eye disease, Paralysis and charcot arthropathy(Charcot joint).

# What are the symptoms of Tabes dorsalis?
- Lightning pains
- Impaired sensation and proprioception
- Hypesthesias
- Progressive sensory ataxia(inability to feel the lower limbs)
- Diminished reflexes or loss of reflexes
- Poor coordination or loss of coordination
- Unsteady gait(locomotor ataxia)
- Sexual function problems

# What causes Tabes dorsalis?
Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue.

# Diagnosis
Physical examination may show:
- Positive romberg test is one of the most important findings in physical examination of patients with tabes dorsalis
- Patient is usually oriented to persons, place, and time
- Hyporeflexia or areflexia may be seen
- Impaired balance bilateral Babinski's Reflex may be present
- Bilateral muscle weakness mostly in lower limbs may be seen
- Argyll Robertson pupils may be present
- Bilateral sensory loss in the extremity mostly in lower limbs may be seen
- Broad base gate and Sensory ataxic gait is usually seen in patients with tabes dorsalis
- Cranial nerve palsy caused by gummatous neurosyphilis may be seen
- Finger-to-nose test is usually abnormal
Tests may include the following::
- Darkfield examinations and tests to detect T. pallidum in lesion exudate or tissue are the definitive methods for diagnosing early syphilis.
- Although no T. pallidum detection tests are commercially available, some laboratories provide locally developed PCR tests for the detection of T. pallidum.
- A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests:
- Nontreponemal tests (e.g., venereal disease research laboratory (VDRL) and rapid plasma reagent test) and
- Treponemal tests (e.g., fluorescent treponemal antibody absorbed (FTA-ABS) tests, the T. pallidum passive particle agglutination (TP-PA) assay, various enzyme immunoassays, and chemiluminescence immunoassays).
- The use of only one type of serologic test is insufficient for diagnosis because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis.
- False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use. Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.

## Nontreponemal test
- Includes VDRL and RPR tests
- Antibody titers may correlate with disease activity
- May reverse following treatment
- Used to follow treatment response
- A fourfold change in titer is necessary to demonstrate significant difference between two nontreponemal tests
- Results from two tests cannot be compared directly with each other

## Trepenomal tests
- Include fluorescent treponemal antibody absorbed (FTA-ABS) tests, T. pallidum passive particle agglutination (TP-PA) assay, enzyme immunoassays, and chemiluminescence immunoassays
- Antibody titers, once positive, remain positive for the rest of the patient's life, regardless of treatment or disease activity
- Cannot be used for monitoring treatment response
- Screening using trepenomal tests may help identify individuals previously treated for syphilis, those with untreated or incompletely treated syphilis, and persons with false-positive results

## Special laboratory findings in neurosyphilis
Neurosyphilis is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through lumbar puncture(LP).
Abnormalities in the CSF consistent with disease include:
- Pleocytosis, often lymphocytic predominant
- Mild protein elevation
- Positive CSF VDRL.
- CSF FTA-ABS can be used but is not specific
CSF abnormalities alone can not make or rule out the diagnosis of neurosyphilis. Every result should be placed in context with the clinical scenario and special finding in imaging and laboratory tests of each patient.

# Treatment options
Penicillin, administered intravenously, is the treatment of choice of tabes dorsalis.. Preventive treatment for those who come into sexual contact with an individual with tabes dorsalis is important. CNS involvement can occur during any stage of syphilis. However, CSF laboratory abnormalities are common in persons with early syphilis, even in the absence of clinical neurological findings. No evidence exists to support variation from recommended treatment for early syphilis for patients found to have such abnormalities. If clinical evidence of neurologic involvement is observed (e.g., cognitive dysfunction, motor or sensory deficits, ophthalmic or auditory symptoms, cranial nerve palsies, and symptoms or signs of meningitis), a CSF examination should be performed. Syphilitic uveitis or other ocular manifestations frequently are associated with neurosyphilis and should be managed according to the treatment recommendations for neurosyphilis. Patients who have neurosyphilis or syphilitic eye disease (e.g., uveitis, neuroretinitis, and optic neuritis) should be treated with the recommended regimen for neurosyphilis; those with eye disease should be managed in collaboration with an ophthalmologist. A CSF examination should be performed for all patients with syphilitic eye disease to identify those with abnormalities; patients found to have abnormal CSF test results should be provided follow-up CSF examinations to assess treatment response.  Associated pain can be treated with opiates, valproate, or carbamazepine. Patients may also require physical or rehabilitative therapy to deal with muscle wasting and weakness

# Where to find medical care for Tabes dorsalis?
Directions to Hospitals Treating Tabes dorsalis

# What to expect (Outlook/Prognosis)?
Progressive disability is possible if the disorder is left untreated.

# Possible complications
Common complications of tabes dorsalis include:
- Dementia, stroke, eye disease
- Paralysis
- Charcot arthropathy(Charcot joint) of the foot may be seen.
- Broad base gate and Sensory ataxic gait is usually seen in patients with tabes dorsalis.

# Sources
-  MAO S, LIU Z (2009). "Neurosyphilis manifesting as lightning pain". Eur J Dermatol. 19 (5): 5046. doi:10.1684/ejd.2009.0712. PMID 19487174..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
-  Vora SK, Lyons RW (2004). "The medical Kipling--syphilis, tabes dorsalis, and Romberg's test". Emerg Infect Dis. 10 (6): 11602. doi:10.3201/eid1006.031117. PMC 3323152. PMID 15224672.
-  Jump up to: 3.0 3.1 Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 60911. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
-  Sabre L, Braschinsky M, Taba P (2016). "Neurosyphilis as a great imitator: a case report". BMC Res Notes. 9: 372. doi:10.1186/s13104-016-2176-2. PMC 4964046. PMID 27465246.CS1 maint: Multiple names: authors list (link)
-  Smikle MF, James OB, Prabhakar P (1988). "Diagnosis of neurosyphilis: a critical assessment of current methods". South Med J. 81 (4): 4524. PMID 3358168.CS1 maint: Multiple names: authors list (link)
-  Mehrabian S, Raycheva M, Traykova M, Stankova T, Penev L, Grigorova O;  et al. (2012). "Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging". BMC Neurol. 12: 96. doi:10.1186/1471-2377-12-96. PMC 3517431. PMID 22994551.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
-  Gue JW, Wang SJ, Lin YY, Liao KK, Wong WW (1993). "Neurosyphilis presenting as tabes dorsalis in a HIV carrier". Zhonghua Yi Xue Za Zhi (Taipei). 51 (5): 38991. PMID 8334567.CS1 maint: Multiple names: authors list (link)
-  Jump up to: 8.0 8.1 Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M (2009). "Case of neurosyphilis presented as recurrent stroke". Oman Med J. 24 (2): 1346. doi:10.5001/omj.2009.29. PMC 3273935. PMID 22334859.CS1 maint: Multiple names: authors list (link)
-  Jump up to: 9.0 9.1 French P (2007). "Syphilis". BMJ. 334 (7585): 1437. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
-  Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R (2006). "Neurosyphilis manifesting as spinal transverse myelitis". Medicina (Kaunas). 42 (5): 4015. PMID 16778468.CS1 maint: Multiple names: authors list (link)
-  Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". J Neuroophthalmol. 26 (2): 1348. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
-  Jump up to: 12.0 12.1 12.2 Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 1603. PMC 2582679. PMID 19148316.CS1 maint: Multiple names: authors list (link)
-  Vogl T, Dresel S, Lochmuller H, Bergman C, Reimers C, Lissner J (1993). "Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings". AJNR Am J Neuroradiol. 14 (6): 132931. PMID 8279327.CS1 maint: Multiple names: authors list (link)
-  Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD (2009). "Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report". Cases J. 2: 8334. doi:10.4076/1757-1626-2-8334. PMC 2769430. PMID 19918420.CS1 maint: Multiple names: authors list (link)
-   Accessed on September 28th, 2016
-  Ratnam S (2005). "The laboratory diagnosis of syphilis". Can J Infect Dis Med Microbiol. 16 (1): 4551. PMC 2095002. PMID 18159528.
-  Jump up to: 17.0 17.1 Morshed MG, Singh AE (2015). "Recent trends in the serologic diagnosis of syphilis". Clin Vaccine Immunol. 22 (2): 13747. doi:10.1128/CVI.00681-14. PMC 4308867. PMID 25428245.
-  Tsang RS, Radons SM, Morshed M (2011). "Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada". Can J Infect Dis Med Microbiol. 22 (3): 837. PMC 3200370. PMID 22942884.CS1 maint: Multiple names: authors list (link)
-  Pastuszczak M, Wojas-Pelc A (2013). "Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines". Postepy Dermatol Alergol. 30 (4): 20310. doi:10.5114/pdia.2013.37029. PMC 3834708. PMID 24278076.
-  Nandwani R, Evans DT (1995). "Are you sure it's syphilis? A review of false positive serology". International Journal of STD & AIDS. 6 (4): 2418. PMID 7548285. |access-date= requires |url= (help)
-  "www.aphl.org" (PDF). Retrieved 2012-12-19.
-  Henao-Martinez AF, Johnson SC (2014). "Diagnostic tests for syphilis: New tests and new algorithms". Neurol Clin Pract. 4 (2): 114122. doi:10.1212/01.CPJ.0000435752.17621.48. PMC 4999316. PMID 27606153.
-  Kaynak G, Birsel O, Guven MF, Ogut T (2013). "An overview of the Charcot foot pathophysiology". Diabet Foot Ankle. 4. doi:10.3402/dfa.v4i0.21117. PMC 3733015. PMID 23919113.CS1 maint: Multiple names: authors list (link)