Tabes dorsalis

73 Tabes dorsalis



Instruction


Examine this patient with lightning pains (lightning denotes that the pains are fleeting and does not necessarily mean they are excruciating).



Salient features



History




• ‘Lightening pains’ are electrical shock like sensation in the limbs, throat, stomach or rectum


• High-stepping gait: patient may only hear their feet slapping the ground and feels as if they are walking on cotton-wool (caused by loss of joint position sense)


• Constipation (this is present as a rule).



Examination




• Examine the eyes:


• Bilateral ptosis with frontalis overaction

• Argyll Robertson pupil (irregular, small pupil which reacts sluggishly to light but reacts to accommodation; Case 39)

• Optic atrophy (primary).

• Examine the sensory system:


• Posterior column signs: look for loss of pain sensation but with normal touch and temperature sensation over the nose, cheeks, inner aspects of the arms and legs, a band across the nipple and in the anal area

• Squeeze calf muscles and the Achilles tendon (evokes no pain as deep sensation is lost).

• Examine:


• the ankle jerks (absent) and plantar response (normal)

• the gait for ataxia (steppage gait) and Romberg’s sign

• the knees and hips for Charcot’s joints

• the feet for trophic ulcers.

• Tell the examiner that you would like to:


• ask the patient about bladder sensation (lost), overflow incontinence and impotence (if male)

• check testicular sensation (usually lost early).

Remember: As a rule, the lower limbs are affected before the upper limbs. Very rarely, the upper limbs may be affected first (cervical tabes).



Diagnosis


This patient has posterior column signs and Argyll Robertson pupil (lesion) caused by tabes dorsalis (aetiology), and has severe ataxia (functional status).

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  4. Dystrophia myotonica

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Tabes dorsalis

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