What is general paresis (of the insane)?

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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This disease is sometimes referred to as dementia paralytica. [22, 27, 28, 29] Typically, it occurs approximately 20-30 years after the initial exposure to Treponema pallidum. It represents a chronic progressive frontotemporal meningoencephalitis with resultant ongoing loss of cortical function.

Pathologically, this type is characterized by a perivascular and meningeal chronic inflammatory reaction with meningeal fibrosis, granular ependymitis, degeneration of the cortical parenchyma (ie, atrophy, gliosis), and tissue invasion with spirochetes. [12] Fisher plaques have been described in advanced stages. These plaques are small demyelinating lesions in brain parenchyma located primarily in the frontal and parietal cortices. [30]

The onset of psychiatric symptoms of general paresis can be insidious, first noticed by family and friends rather than the patient. These include loss of ambition at work, memory lapses, irritability, unusual giddiness, apathy, withdrawal, and a decline in attention to personal affairs. Later, patients may present with mental changes simulating schizophrenia, euphoric mania, paranoia, toxic psychosis, or presenile dementias. Presenile dementia is most common, manifesting with depression, confusion, and severe impairment of memory and judgment.

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