What is tabes dorsalis?

Updated: Jul 17, 2018
  • Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Tabes dorsalis is a slowly progressive parenchymatous degenerative disease involving the posterior columns (ie, demyelination) and posterior roots (ie, inflammatory change with fibrosis) of the spinal cord. Thus, the neurologic presentation is one of ongoing loss of pain sensation, loss of peripheral reflexes, impairment of vibration and position senses, and progressive ataxia.

Bladder incontinence and loss of sexual function are common. Lancinating pain (ie, lightning-like, appearing suddenly, spreading rapidly, and disappearing) often is an early symptom and requires treatment. The severe painful crisis develops after stress or exposure or without apparent precipitant in approximately 90% of patients. Visceral crises occur in approximately 15% of patients. These include episodes of excruciating epigastric pain with associated nausea and vomiting.

The 3 stages of tabes dorsalis are preataxia, ataxia, and paralysis. The characteristic gait is wide-based and slapping. Charcot joints and trophic ulcers (mal perforans) often develop.

Tabes dorsalis has become uncommon, but this is likely to be the only manifestation of neurosyphilis that has been altered during the antibiotic era.

The neurologic examination may show areflexia, loss of proprioceptive sense with sensory ataxia, and Argyll Robertson pupils. Typically, these pupils are bilaterally small (miotic) and fail to constrict further in response to light but do demonstrate normal constriction to accommodation. This is caused by lesions in the area immediately rostral to the nucleus of Edinger-Westphal (periaqueductal gray). Nonsyphilitic causes of Argyll Robertson pupil include diabetes mellitus, multiple sclerosis, Wernicke encephalopathy, Lyme disease, sarcoidosis, herpes zoster, tumor, and hemorrhage. [26]

No spirochetes have been found in the posterior columns. The causes of the tabetic (from the Latin word, which means shriveling) changes are unclear. Onset of this syndrome is often 20-30 years after the initial infection. Treatment is unsatisfactory; penicillin does not reverse the symptoms, although it may normalize CSF abnormalities.

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