Analysis of clinical and imaging characteristics of tabes dorsalis

Abstract

Objective To analyze the characteristics of clinical symptoms and imaging features of tabes dorsalis.  Methods We retrospectively analyzed clinical signs and symptoms, laboratory examinations, imaging features, electrophysiological manifestations, treatment and prognosis of 3 patients with tabes dorsalis diagnosed in our hospital and 7 patients reported in literatures.  Results The initial symptoms of 10 patients with tabes dorsalis included unsteady gait, pricking or lightning pain in abdomen and numbness of limbs (especially in both legs and feet). In addition to the above symptoms, the most common clinical features also included urination disorders, weakened or disappeared reflexes at knee and ankle, disorders of deep and shallow sensation, Romberg sign positive and heel-knee-tibia test instability. Treponema pallidum particle agglutination assay (TPPA) in serum of all patients was positive, and the titer of rapid plasma reagin (RPR) in serum was 1∶ 8-256. Cerebrospinal fluid (CSF) test showed increased white blood cell and protein. TPPA in CSF was also positive, and the titer of RPR in CSF was 1∶1-8. No obvious specificity of imaging changes was found except spinal disc degeneration. Some patients showed abnormal somatosensory-evoked potential (SEP) with prolonged latency and decreased amplitude of bilateral P100 waves, and the nerve conduction velocity (NCV) of most patients was normal. Six patients were improved after penicillin treatment.  Conclusions Due to its complicated clinical manifestations and non-specific imaging changes, tabes dorsalis is prone to be misdiagnosed. A clear diagnosis depends on clinical signs and symptoms, laboratory examinations, imaging and electrophysiological manifestations. Only a minority of patients show imaging changes which are proved significant for the diagnosis of tabes dorsalis.

DOI: 10.3969/j.issn.1672-6731.2016.07.006