Tabes dorsalis

Signs and symptoms

Tabes dorsalis can remain silent for decades after the initial infection. Symptoms include weakness, reduced reflexes, and abnormal sensations like shooting or burning pains, pricking feelings, or the sensation of insects crawling on the skin. There may also be a diminished sense of touch, a slapping, unsteady gait (tabetic gait), progressive joint damage, poor coordination, intense pain episodes including tongue pain, personality shifts, loss of bladder control, dementia, hearing loss, vision problems, a positive Romberg's test, and Argyll Robertson pupils. Muscles become floppy because the sensory part of the stretch reflex is destroyed.

Deep tendon reflexes, such as the knee jerk, are weak or absent (Westphal's sign). A complication is sudden, severe eye pain with tearing and light sensitivity, once called Pel's crises, now known as tabetic ocular crises. Lancinating back pain, called tabes dorsalgia, is related. The tabetic gait results from lost proprioception; the person's feet slap the floor, but they can reduce unsteadiness by watching their feet in daylight.

Society and culture

Tabes dorsalis, a late-stage complication of syphilis, has been linked to several notable historical figures. The German writer E.T.A. Hoffmann likely had the condition and died from it in 1822. Mary Todd Lincoln, First Lady of the United States from 1861 to 1865, probably developed tabes dorsalis around 1869, when she was 51; she later died of a stroke at age 63 in Springfield, Illinois. French novelist Alphonse Daudet documented his pain from the disease in a journal, published after his death as La Doulou in 1930 and later translated into English by Julian Barnes as In the Land of Pain in 2002.

Poet Charles Baudelaire, who contracted syphilis in 1839, used opium to manage the pain as tabes dorsalis ascended his spine. Painter Édouard Manet died in 1883 at age 51 from syphilis complications, including tabes dorsalis. Boxer Charley Mitchell and Meyer Nudelman, father of author Sherwin Nuland, also suffered from the condition. In popular culture, the medical drama House featured the disorder in season 8, episode 6, where a father's diagnosis provided the eureka moment for identifying neurosyphilis in a teenage patient.

Did You Know?

• The spirochete invades large myelinated fibers, leading to involvement of the dorsal column medial lemniscus pathway rather than the spinothalamic tract.
• Associated pain can be treated with opiates, valproate, or carbamazepine.