Diseases of the nervous system : a text-book of neurology and psychiatry . dradial periosteal reflexes are likewise early and fairly constant phenom-ena, though less marked than the changes in the lower extremities. These tendon-reflex changes are all referable to the degenerationsin the root zones and sensory columns. 564 SYPHILIS OF THE NERVOUS SYSTEM Cranial Nerve Involvement.—Any one or all of the cranial nerves maybe implicated. Loss of smell is rare. Pupillary Reflexes.—Here a striking phenomenon is with tabes—as with many other syphilitic affections of themedullary or
Diseases of the nervous system : a text-book of neurology and psychiatry . dradial periosteal reflexes are likewise early and fairly constant phenom-ena, though less marked than the changes in the lower extremities. These tendon-reflex changes are all referable to the degenerationsin the root zones and sensory columns. 564 SYPHILIS OF THE NERVOUS SYSTEM Cranial Nerve Involvement.—Any one or all of the cranial nerves maybe implicated. Loss of smell is rare. Pupillary Reflexes.—Here a striking phenomenon is with tabes—as with many other syphilitic affections of themedullary or midbrain region^—show a diminution or loss of the pupil-lary light reflexes, without any loss of the reflex of convergence or ofaccommodation. This is the Argyll-Robertson phenomenon. It ispresent in over 60 per cent, of the cases, and may be present formany years without other symptoms. The pupils are apt to be at firstirregular in size, and also not infrequently in shape. The light reac-tion is at first less prompt—usually in one eye before the other—later. Fig. 287.—Tabes. Third and sixth nerve palsy. both eyes are involved. Myosis in marked degree is then apt todevelop. Loss of the consensual light reflex is one of the earliestsigns of this pupillary change (Weiler). The sympathetic dilatation ofthe pupils is also soon diminished or lost. Oj)tic nerve changes are frequent and may occur early. There is anirregular gray atrophy, with narrowing of the macular vessels andgradual narrowing of the visual field, first for colors and then blind-ness, partial or complete, with advanced optic atrophy. Ocular Palsies.—These very frequently belong to the early symptom-atology and are often fleeting. Persisting ocular palsies are moreoften encountered in the later stages of the disease. These palsies intabes occur quite irregularly and show themselves as atonic ptoses, TABES 565 irregular diplopias—from fourth or sixth or third nerve affections—and rarely show signs
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