Tabes dorsalis is a degeneration of the sensory neurons in the dorsal column of the spinal cord caused by untreated syphilis. It primarily affects males during mid-life. Clinical features include sensory disturbances like lightning pains, root pain, and tabetic crises. Objective findings include loss of position and vibration sense in the lower limbs and sensory ataxia. Deep reflexes like ankle jerks are lost. Treatment involves penicillin injections to treat the underlying syphilis infection along with medications for pain management and physiotherapy.

1. Tabes dorsalis
Sanket pandya
(TY BPT)

2. Defination
Tabes dorsalis is defined as a degeneration of sesory
neurons in dorsal Column of spinal cord.

3.  Tabes dorsalis is caused by demyelination secondary to an
untreated syphilis infection.
 Syphilitic melopathy is a complication of untreated syphilis that
involves muscle weakness and abnormal sensation.
 The diseases is more frequently in males than in females.
 Onset is commonly during mid-life.
 The incidence of tabes dorsalis is rising,in part due to co associated
HIV infection.

5. Clinical features:
(A) Subjective sensory disturbances: the patient
may complain of one of the following;
1)Lightening pains: These are pains which come suddenly
and go suddenly, like lightening, and at different sites
during each episode. These occur classically in tabes
dorsalis.
2)Fixed pains: These pains are dull aching (slite headache)
and constant at a particular site.
3)Root pain : These are root pain in the lower thoracic I.e
the girdle area,sciatica.
4)Pain of tabetic crisis: paroxysmal painful disorder if the
function of various viscera e.g.
Gastric,rectal,nasal,laryngeal, renal,urethral,etc...

6.  5)patient may have the feeling of walking on the cotton
wool due to affection of the posterior columns.

7. (B)Objective sensory loss:
1)There is loss of position and vibration sense almost
always involving the lower limbs and sometimes involving
the upper limbs due to affection of posterior column.
2) pain,temperature and touch are affected late. The
common area of affection are butterfly area of the
face,inner of the arms,saddle shaped area around the
anus and over gendo achillis.
3)Loss of testicular sense.

10. (C) hypotonia:
Being a lower motor neurone disease due to affection of the nerve
root distal to the posterior root ganglion there is hypotonia.

11. (D)Ataxia:
Due to the posterior column affection there is loss of
position and vibration sense which leads to sensory ataxia.
Hence the romberg’s sign is positive.

12. (E) Disturbances in reflexes:
The deep reflexes are lost especially the ankle and knee
jerks which must always be lost in a case of tabes dorsalis.

13. (F) Disturbance in pupils:
 The patient may have small,unequal or irregular pupils.
 There may be agryll roberson or reverse agryll roberson
pupils.

14. (G) Attitude and gait:
 The patient stand on a wide base with eyes fixed to the
ground.
 When he wishes to walk,due to hypotonia the limb is lifted
to a greater extent than normal and because the position
sense is affected,it is brought down with a stamp(high
stamping gait).

15. (H)Sphincter disturbances:
 Impotence is sometimes an early symptom.
 There may be incontinence of urine and feces.
 The classical disturbances is a loss of bladder sense.hence
the bladder accumulates urine with the patient unaware.
This gives a false impression of retention of urine.
However,in Tabes dorsalis the patient can voluntarily
evacuate his bladder.

17. (I)Trophic change:
 Perforgating ulcers occur usually on the pad of the great
toe.
 Charcot’s joints:- painless swelling of the knee joints.

18. (J) Crisis:
 As describe in sensory disturbances above.
 CSF picture:- proteins may be raised ,especially gamma
globulins,there may be mononuclear cells, usually not
more than 100/cc.

19. Investigation
 CSF examination
 CT or MRI of the brain and spinal cord to rule out other diseases
 Serum VDRL or serum RPR

20. Treatment:
Specific:
1)Penicillin – banzathine penicillin 2.4 mega units Intra
muscular, per week. for 4 weeks.
It may be repeated after 4 to 6 months.
2)Conclusive shock therapy for psychiatric symptoms.

21. Symptomatic:
1. Lightening pain:- analgesics and carbamzepine.
2. Tabetic crisis:- carbamazepine.
3. Ataxia:- physiotherapy and use of walking sticks.
4. Bladder disturbances:- training the patient to evacuate
his bladder at regular intervals irrespective of
dribbling,the patient must be advised to carry a
portable receptacle.

22. Refrence:
P.j.mehta’s practical medicine
Edition 21st

23. Guided by;
Seniors
&
Dr. Nipa patel