Spinal Syphilis

　　Spinal syphilis is caused by an infectious microorganism called Treponema pallidum, a thin, spiral-shaped, and mobile microorganism. This spiral often enters the central nervous system 3 to 18 months after infection in the human body.

　　Spinal syphilis can complicate syphilitic heart disease, which often occurs 10 to 20 years after syphilis. Syphilitic heart disease mainly invades the aorta, and in the early stage, there are no自觉 symptoms, while in the late stage, it may present with heart failure, angina pectoris, cough, hoarseness, and other symptoms.

　　Syphilis of the spinal cord includes spinal tuberculosis, syphilitic meningitis and myelitis, and syphilitic meningovascular syphilis. The specific clinical manifestations are as follows:

　　Firstly, tabes dorsalis
　　It usually occurs 15 to 20 years after syphilis infection, more common in males, with main symptoms such as lightning-like pain, sensory ataxia, and urinary incontinence. The main signs include the disappearance of the patellar and ankle reflexes, impairment of the vibration and position sense in the lower limbs, and a positive Romberg's sign when closing the eyes.
　　1. Ocular manifestations: More than 90% of patients have abnormal pupils, usually presenting as unequal, small, and irregular pupils, with the absence of light reflex but the presence of accommodation reflex. Most of them are accompanied by ptosis and varying degrees of ophthalmoplegia. Optic atrophy is also common.
　　2. Sensory disturbance: More than 90% of patients experience lightning-like pain, more common in the lower limbs, but can also pain from the face to the lower limbs. The pain is sharp and transient, with a nature resembling lightning, knife-cutting, or tearing, and occasionally persistent pain in one place. Ataxia is simply caused by deep sensory disturbance, with a gait that is unsteady and lurching (with excessive elevation of the lower limbs during walking, more forceful stepping, and uneven size of each step). In the late stage, even if the muscle strength is intact, it is difficult to walk.
　　3. Sphincter dysfunction: Due to the damage of the posterior roots of the lumbar 2-4 segments, affecting bladder sensation, the bladder is full without the desire to urinate, resulting in overflow incontinence.
　　4. Organ crisis: The most common is gastric crisis, presenting as sudden epigastric or upper abdominal pain, which can extend to the chest, with a sense of contraction in the chest, accompanied by nausea and vomiting. Vomiting is often repeated until bile is vomited. After the attack, the patient often feels exhausted and the skin over the upper abdomen is sore. In the crisis of the small intestine, there are severe cramps and diarrhea. In the crisis of the pharynx and larynx, there are attacks of dysphagia and difficulty in breathing. In the rectal crisis, there is urgency and a feeling of tenesmus. In the genitourinary crisis, there is pain and difficulty in urination. Besides the gastric crisis, other crises are rare.

　　Secondly, syphilitic meningomyelitis and meningovascular syphilis
　　It usually occurs 3 to 5 years after syphilis infection. Syphilitic meningomyelitis, mainly due to the damage of the bilateral corticospinal tract, and some involving the meninges mainly, often manifests as neck and shoulder pain, muscle atrophy, and long tract signs in the lower limbs due to thickening, adhesion of the meninges, and compression of the nerve roots and spinal cord.
　　Syphilitic meningovascular myelitis mainly involves the vascular involvement, often caused by thrombosis of the spinal cord vessels due to endarteritis. The disease onset is rapid, and the symptoms depend on the range of the vessels involved. Occasionally, anterior spinal artery thrombosis can cause an anterior spinal artery syndrome, with deep sensation remaining intact.

　　The prevention of syphilitic myelitis mainly involves preventing syphilis, a sexually transmitted disease. Since the liberation of China, due to the government's strict prohibition of prostitution and solicitation, as well as the implementation of mass surveys and prevention in some areas, by the end of the 1950s, the disease had basically been eradicated. In some countries in Europe and America, the incidence of syphilis also significantly decreased due to early diagnosis and treatment, as well as the application of penicillin and other drugs. However, in the past decade or so, there has been an increase in new syphilis patients in China, especially those with meningovascular syphilis, and some are accompanied by AIDS. Therefore, it is necessary to strengthen the publicity of medical and health knowledge, improve cultural and quality education, make people aware of the harm of sexually transmitted diseases, and even control them from certain systems, so as to prevent and control the occurrence of the disease from the source.

　　The diagnosis of spinal cord syphilis, in addition to clinical manifestations, also requires auxiliary examinations. The following are common examinations:
　　1. Cerebrospinal fluid examination is a sensitive indicator of active neurosyphilis, and patients with neurosyphilis often show abnormalities, with an increased cell count of (200～300)×10^6/L, mostly lymphocytes and a small number of plasma cells and monocytes, an increased cerebrospinal fluid protein of 0.4～2g/L, and an increased cerebrospinal fluid IgG. The sugar level is generally normal.
　　2. Serological tests for syphilis include non-specific sexually transmitted disease screening tests, flocculation tests, and specific treponemal immunofluorescence adsorption tests and treponemal agglutination reactions.
　　3. Routine blood tests, electrolytes, blood sugar, and immune tests have differential diagnostic significance
　　4. Imaging examinations such as CT and MRI can show single or several smaller low-density infarction foci in the lesion tissue.

　　In addition to conventional Western medicine treatment for spinal cord syphilis, dietary adjustments are also needed.A reasonable diet can increase the intake of high-fiber foods and fresh vegetables and fruits, achieve a balanced diet including proteins, sugars, fats, vitamins, trace elements, and dietary fibers, mix meat and vegetables, diversify food varieties, and give full play to the complementary effects of nutrients between foods, which is also very helpful in preventing this disease..

　　Penicillin is the first-line drug for syphilis of the spinal cord. Treatment with penicillin may cause a first-dose reaction, manifested as mild fever and increased white blood cell count. Some symptoms of neurosyphilis may not respond to penicillin treatment, especially tabes dorsalis, and therefore, other medications need to be added. Phenytoin (phenytoin sodium) or carbamazepine can be used for lightning-like pain, and analgesics can also be chosen, but opiate drugs must be avoided. Derivatives of atropine and phenothiazines are effective for visceral crises.