WordNet

a short strip of material attached to or projecting from something in order to facilitate opening or identifying or handling it; "pull the tab to open the can"; "files with a red tab will be stored separately"; "the collar has a tab with a button hole"; "the filing cards were organized by cards having indexed tabs"
belonging to or on or near the back or upper surface of an animal or organ or part; "the dorsal fin is the vertical fin on the back of a fish and certain marine mammals"
wasting of the body during a chronic disease

PrepTutorEJDIC

(開けるたれの)つまみ;(持つ・つるすための)ひもの輪;(区別するための)付け札,ラベル / (衣服につける装飾用の)ひも,輪,垂れ飾り;(靴の)舌革など / 《話》(食事などの)勘定;つけ
(植物の)背部の,背の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/13 10:41:12」(JST)

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Tabes dorsalis, also known as syphilitic myelopathy, is a slow degeneration (specifically, demyelination) of the nerves primarily in the dorsal columns (posterior columns) of the spinal cord (the portion closest to the back of the body). These nerves normally help maintain a person's sense of position (proprioception), vibration, and discriminative touch.

Signs and symptoms

Axial section of the spinal cord showing syphilitic destruction (whitened area, upper center) of the posterior columns which carry sensory information from the body to the brain

Signs and symptoms may not appear for decades after the initial infection and include weakness, diminished reflexes, paresthesias (shooting and burning pains, pricking sensations, and formication), hypoesthesias (abnormally diminished cutaneous, especially tactile, sensory modalities), tabetic gait (locomotor ataxia), progressive degeneration of the joints, loss of coordination, episodes of intense pain and disturbed sensation (including glossodynia), personality changes, urinary incontinence, dementia, deafness, visual impairment, positive Romberg's test, and impaired response to light (Argyll Robertson pupil). The skeletal musculature is hypotonic due to destruction of the sensory limb of the spindle reflex. The deep tendon reflexes are also diminished or absent; for example, the "knee jerk" or patellar reflex may be lacking (Westphal's sign). A complication of tabes dorsalis can be transient neuralgic paroxysmal pain affecting the eyes and the ophthalmic areas, previously called "Pel's crises" after Dutch physician P.K. Pel. Now more commonly called "tabetic ocular crises," an attack is characterized by sudden, intense eye pain, tearing of the eyes and sensitivity to light.^[1]^[2]

"Tabes dorsalgia" is a related back pain.

"Tabetic gait" is a characteristic high-stepping gait of untreated syphilis where the person's feet slap the ground as they strike the floor due to loss of proprioception.

Cause

Tabes dorsalis is caused by demyelination secondary to an untreated syphilis infection.^[3]

Treatment

Intravenously administered penicillin is the treatment of choice. Associated pain can be treated with opiates, valproate, or carbamazepine. Those with tabes dorsalis may also require physical therapy to deal with muscle wasting and weakness. Preventive treatment for those who come into sexual contact with an individual with syphilis is important.

Prognosis

Left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness. Existing nerve damage cannot be reversed.

Epidemiology

The disease is more frequent 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.

Notable researchers

Although there were earlier clinical accounts of this disease, and descriptions and illustrations of the posterior columns of the spinal cord, it was the Berlin neurologist Romberg whos account became the classical textbook description, first published in German^[4] and later translated into English.^[5]

Sir Arthur Conan Doyle, author of the Sherlock Holmes stories, completed his doctorate on tabes dorsalis in 1885.^[6]

Notable patients

German storywriter E.T.A. Hoffmann appears to have suffered and died from tabes dorsalis.
The French novelist Alphonse Daudet kept a journal of the pain he experienced from this condition which was posthumously published as La Doulou (1930) and translated into English as In the Land of Pain (2002) by Julian Barnes.
Poet Charles Baudelaire contracted syphilis in 1839 and resorted to opium to help alleviate the pain of tabes dorsalis ascending his spine.
Painter Édouard Manet died of syphilis complications, including tabes dorsalis, in 1883, aged 51.
Boxer Charley Mitchell (boxer)

References

tabes_dorsalis at NINDS
-1294991357 at GPnotebook
'An Essay Upon the Vasomotor Changes in Tabes Dorsalis' by Arthur Conan Doyle

^ "Pel's Crisis". Retrieved December 14, 2009.
^ Basic Clinical Neuroscience, Young, Young, and Tolbert. Lippincott, Williams, and Wilkins, ISBN 978-0-7817-5319-7
^ "NINDS Tabes Dorsalis Information Page". Retrieved April 13, 2014.
^ Romberg, Moritz (1840). Lehrbuch der Nervenkrankheiten des Menschen. Berlin: Duncker.
^ Romberg, Moritz (1853). Tabes dorsalis. Chapter 49 in: A manual of the nervous diseases of man Vol 2 (Translated and edited by EH Sieveking ed.). London: New Sydenham Society. p. 395.
^ http://www.era.lib.ed.ac.uk/handle/1842/418

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 神経梅毒 neurosyphilis
2. 脊髄に影響を与える疾患 disorders affecting the spinal cord
3. Syphilis: Treatment and monitoring
4. 感覚消失患者へのアプローチ approach to the patient with sensory loss
5. Syphilis: Epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients

English Journal

Moritz Heinrich Romberg (1795-1873): Early founder of neurology.

Housman B, Bellary SS, Walters A, Mirzayan N, Tubbs RS, Loukas M.SourceDepartment of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies.
Clinical anatomy (New York, N.Y.).Clin Anat.2012 Jun 18. doi: 10.1002/ca.22112. [Epub ahead of print]
Moritz Heinrich Romberg (1795-1873) began his pursuit of neurology in 1820 by translating into German Andrew Marshall's The Morbid Anatomy of the Brain. In 1830, Romberg was hired as Privatdozent of special pathology and therapy in the Charité, the University Hospital of Berlin. He quickly rose to
PMID 22711686

Charcot-Marie-Tooth disease presenting as a nonhealing ulcer in a 26-year-old man.

Judhan RJ, Maharaj SR, Perry A, Dellon AL, Maharaj D.SourceDepartment of General Surgery, Port of Spain General Hospital, University of the West Indies, 18 Elizabeth Street, Trinidad, West Indies.
Microsurgery.Microsurgery.2012 Mar;32(3):223-6. doi: 10.1002/micr.21947. Epub 2012 Feb 27.
A 26-year-old man presented with a nonhealing ulcer on the plantar aspect of the left foot of five years duration. Initial investigations were unremarkable. It was only after careful neurological examination that an inherited neuropathy was suspected. This was confirmed by nerve conduction studies a
PMID 22371199

Japanese Journal

脊髄癆を原因とした Charcot spine に対し脊椎固定術を行った1例

木船史朗,遠藤健司,鈴木秀和,田中英俊,山本謙吾,松林純
関東整形災害外科学会雑誌 43(5), 344-347, 2012-10-01
NAID 10031117701

Successful treatment of tabetic lightning pain and visceral crisis with gabapentin

OSHITA Kyoko,SAEKI Noboru,NIINAI Hiroshi,HAMADA Hiroshi,KAWAMOTO Masashi
Journal of anesthesia 25(6), 952, 2011-12-20
NAID 10030449182

神経梅毒 (特集治療可能な認知症--Update)

野澤宗央,一宮洋介,新井平伊
老年精神医学雑誌 19(9), 970-974, 2008-09
NAID 40016257708

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