Tabes dorsalis

Published on 05/05/2015 by admin

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Last modified 05/05/2015

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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).

• 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

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