General Paresis

General paresis (syphilitic meningoencephalitis) is a chronic meningoencephalitis from T. pallidum invading brain parenchyma—the most severe form of neurosyphilis. First described by Haslam (1798). It presents with progressive mental deterioration to dementia and tremor; pathologically, the brain parenchyma is mainly affected, eventually causing paralysis and worsening intellectual/personality change, hence also called progressive/general paralysis.

Common Symptoms

Fatigue; persecution delusions; hyperesthesia; ataxia; ptosis; restlessness; vacant stare; depression

Causes and Pathogenesis

Detecting treponemes in the demented brain was a milestone in psychiatry, showing one etiology can produce diverse psychiatric symptoms. Pathology: cerebral atrophy, especially frontal lobe; neuronal degeneration/loss and cortical disorganization cause dementia. Historical timeline: Bayle (1822) viewed all symptoms as chronic meningitis; Rokitansky (1857) described interstitial encephalitis with secondary parenchymal damage; Esmark/Jenssen (1857) linked it to prior syphilis; Fournier (1894) statistically confirmed the association; Wassermann's CFT (1906) and Noguchi/Moore (1913) found treponemes in 14/70 brains. Host reactivity, trauma, fatigue, alcoholism, other infections, and mental trauma may predispose. Some propose a neurotropic treponeme strain or allergic mechanism, but evidence is inconclusive. Pathogenesis: chronic leptomeningitis—cloudy thickened leptomeninges (frontal worst), generalized cortical atrophy, ventricular dilation, granular ependymitis (sand-like elevations on fourth ventricular floor, pathognomonic). Microscopy: plasma cell/lymphocytic perivascular infiltration, glial proliferation, diffuse neuronal degeneration/loss with severe cortical disorganization (especially small/medium pyramidal cells, frontal worst); two special findings are free iron deposition and treponemes in middle/deep cortex. Different CNS sites cause different clinical signs.

Treatment

Drug therapy, supportive therapy

Preventive Measures

After the 1950s, China essentially eliminated syphilis through prohibition of prostitution and mass campaigns; Western countries saw declines after early diagnosis and penicillin. Recent years have seen resurgence (often with HIV). 1. Treat early syphilis promptly and adequately, preferably with penicillin. 2. Follow-up: if non-treponemal titers fail to decline or drop <2 dilutions in 6 months (especially non-penicillin treatment), do CSF exam. 3. Any patient with prior syphilis plus hearing/cranial-nerve/meningeal/visual damage should be evaluated for neurosyphilis. 4. Treponemal-positive patients with unexplained neuropsychiatric disease need neurosyphilis workup/treatment.

Department to Visit

It is recommended to visit the Neurology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.