関: asymptomatic neurosyphilis、CNS syphilis、general paralysis、neurosyphilis、symptomatic neurosyphilis

WordNet

syphilis of the central nervous system
somewhat indefinite; "bearing a general resemblance to the original"; "a general description of the merchandise"
a general officer of the highest rank (同)full general
the head of a religious order or congregation (同)superior general
a fact about the whole (as opposed to particular); "he discussed the general but neglected the particular"
affecting the entire body; "a general anesthetic"; "general symptoms"
applying to all or most members of a category or group; "the general public"; "general assistance"; "a general rule"; "in general terms"; "comprehensible to the general reader"
command as a general; "We are generaled by an incompetent!"
not specialized or limited to one class of things; "general studies"; "general knowledge"
prevailing among and common to the general public; "the general discontent"
a slight or partial paralysis

PrepTutorEJDIC

(あるグループ)『全部の』,全部を含む / 『世間一般の』,広く行き渡った / 『一般の』,専門的でない / 『大体の』,概略の / 『陸軍大将』;(陸軍の)『将軍』,将官 / 概して,一般に
不全麻痺,局部的運動麻痺
genusの複数形

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/23 05:57:41」(JST)

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This article is about the neuropsychiatric disorder. For the physical malady, paralysis, see paresis.

General paresis, also known as general paralysis of the insane or paralytic dementia, is a neuropsychiatric disorder affecting the brain, caused by late-stage syphilis. GPI was originally considered a psychiatric disorder when it was first scientifically identified around the nineteenth century, as the patient usually presented with psychotic symptoms of sudden and often dramatic onset. It is rare in most developed countries.

General paresis is based on the chronic meningoencephalitis that leads to cerebral atrophy. Degenerative changes are associated primarily with the frontal and temporal lobar cortex. Like syphilis itself, general paralysis is also treated with penicillin. The disease affects around 7 % of infected individuals, it also prevails among men.

Signs and symptoms

Symptoms of the disease first appear from 10 to 30 years after infection. Incipient GPI is usually manifested by neurasthenic difficulties, such as fatigue, headaches, insomnia, dizziness, etc. As the disease progresses, the mental deterioration and personality changes occurs. Typical symptoms include loss of social inhibitions, asocial behavior, gradual impairment of judgement, concentration and short-term memory, euphoria, mania, depression, or apathy. Subtle shivering, minor defects in speech and Argyll Robertson pupil may become noticeable.

Delusions, which are common, tend to be poorly systematized and absurd. They can be grandiose, melancholic, or paranoid. These delusions include ideas of great wealth, immortality, thousands of lovers, unfathomable power, but also apocalypse, nihilism, self-blame, or bizarre hypochondriacal complaints. Later, the patient suffers from dysarthria, intention tremors, hyperreflexia, myoclonic jerks, confusion, seizures and pareses. Eventually, the paretic dies bedridden, cachectic and completely disoriented.

Diagnosis

The diagnosis could be differentiated from other known psychoses and dementias by a characteristic abnormality in eye pupil reflexes (Argyll Robertson pupil), and, eventually, the development of muscular reflex abnormalities, seizures, memory impairment (dementia) and other signs of relatively pervasive neurocerebral deterioration. Definitive diagnosis is based on the analysis of cerebrospinal fluid and tests for syphilis.

Prognosis

Although there were recorded cases of remission of the symptoms, especially if they had not passed beyond the stage of psychosis, these individuals almost invariably suffered relapse within a few months to a few years. Otherwise, the patient was seldom able to return home because of the complexity, severity and unmanageability of the evolving symptom picture. Eventually, the patient would become completely incapacitated, bedfast, and die, the process taking about three to five years on average.

History

While retrospective studies have found earlier instances of what may have been the same disorder, the first clearly identified examples of paresis among the insane were described in Paris after the Napoleonic Wars. General paresis of the insane was first described as a distinct disease in 1822 by Antoine Laurent Jesse Bayle. General paresis most often struck people (men far more frequently than women) between twenty and forty years of age. By 1877, for example, the superintendent of an asylum for men in New York reported that in his institution this disorder accounted for more than twelve percent of the admissions and more than two percent of the deaths.

Originally, the cause was believed to be an inherent weakness of character or constitution. While Esmarch and Jessen had asserted as early as 1857 that syphilis caused general paresis, progress toward the general acceptance by the medical community of this idea was only accomplished later by the eminent nineteenth-century syphilographer Alfred Fournier (1832–1914). In 1913 all doubt about the syphilitic nature of paresis was finally eliminated when Hideyo Noguchi and J. W. Moore demonstrated the syphilitic spirochaetes in the brains of paretics.

In 1917 Julius Wagner-Jauregg discovered that infecting paretic patients with malaria could halt the progression of general paresis. He won a Nobel Prize for this discovery in 1927. After World War II the use of penicillin to treat syphilis made general paresis a rarity: even patients manifesting early symptoms of actual general paresis were capable of full recovery with a course of penicillin. The disorder is now virtually unknown outside developing countries, and even there the epidemiology is substantially reduced.

In her 1915 novel, The Song of the Lark, Willa Cather referred to the insanity of the wife of a main character as having been caused by general paresis but there is no hint that the character had contracted syphilis. In her 1953 novel, A Pocket Full of Rye, Agatha Christie used paresis as an explanation for the behavior of the victim. She did not mention the syphilitic connection.

UpToDate Contents

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English Journal

Operative treatment of subcortical metastatic tumours in the central region.

Walter J, Kuhn SA, Waschke A, Kalff R, Ewald C.SourceDepartment of Neurosurgery, Friedrich-Schiller-University, Erlanger Allee 101, 07747, Jena, Germany, jan.walter@med.uni-jena.de.
Journal of neuro-oncology.J Neurooncol.2011 Jul;103(3):567-73. Epub 2010 Sep 29.
The operative treatment of subcortical metastatic tumours within the paracentral area is still under discussion. Against the background of possible new postoperative neurological deficits and of evolving new radio oncological techniques, the indication for surgery is limited only to a subgroup of pa
PMID 20878448

The great pretender.

Wasserman S, Vallie Y, Bryer A.SourceDepartment of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa. sean.wasserman@uct.ac.za
Lancet.Lancet.2011 Jun 4;377(9781):1976.
PMID 21641480

Japanese Journal

難治性良性発作性頭位めまい症と考えられた1例

犬飼賢也,高橋紳一郎,肥塚泉
Equilibrium Research 70(1), 17-22, 2011
… On June 20, 2007, she was referred to the Otolaryngology Department of Tachikawa General Hospital. … A caloric test did not show canal paresis. …
NAID 130000674853

Repeated Non-enhancing Tumefactive Lesions in a Patient with a Neuromyelitis Optica Spectrum Disorder

Ikeda Ken,Ito Hirono,Hidaka Takanobu,Takazawa Takanori,Sekine Tokinori,Yoshii Yasuhiro,Hirayama Takehisa,Kawabe Kiyokazu,Kano Osamu,Iwasaki Yasuo
Internal Medicine 50(9), 1061-1064, 2011
… Neurological examination showed motor aphasia, finger agnosia, right-left disorientation, and right hand paresis. …
NAID 130000650114

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リンク元	「進行麻痺」「CNS syphilis」「asymptomatic neurosyphilis」「symptomatic neurosyphilis」「general paralysis」
関連記事	「general」「genera」