Tabes Dorsalis: Late Neurosyphilis Symptoms and Progression

Tabes Dorsalis: Posterior Column Degeneration from Untreated Syphilis

Tabes dorsalis manifests decades after primary infection due to demyelination of dorsal columns and dorsal roots.

Early Symptoms (Sensory Ataxia Predominates)

• Gait ataxia (wide-based, stomping, worse in dark/Romberg+).
• Lightning pains: sudden, severe, lancinating leg/visceral pain.
• Loss of vibration, proprioception, deep tendon reflexes (areflexia).
• Impaired coordination (pseudoathetosis).

Late Symptoms (Cranial Nerve & Autonomic Involvement)

• Argyll Robertson pupils (accommodate but don't react to light).
• Optic atrophy → blindness.
• Deafness (VIII nerve).
• Dysarthria, dysphagia (bulbar).
• Neurogenic bladder/bowel (incontinence).
• Dementia, psychiatric changes.
• Charcot joints (neuropathic arthropathy).

Diagnosis & Treatment

• CSF: lymphocytic pleocytosis, ↑ protein, +VDRL/FTA-ABS.
• IV Penicillin G 18–24 million units/day × 10–14 days.
• Symptomatic: gabapentin/pregabalin for lightning pains; PT for gait.
• Damage largely irreversible; treatment halts progression.