Which sign would you expect in a patient with tabes dorsalis neurosyphilis due to untreated syphilis?

Which sign would you expect in a patient with tabes dorsalis neurosyphilis due to untreated syphilis?

• A. Abnormal gait
• B. Blindness
• C. Hyperreflexia
• D. Stiff neck

Answer: (A)

Tabes dorsalis damages the dorsal columns and dorsal roots, which carry fine touch and proprioception. When proprioceptive feedback is lost, the body can’t sense where the limbs are, so movement becomes uncoordinated and unstable. The characteristic result is a sensory ataxic gait: a wide-based, unsteady walk, often with a positive Romberg sign and foot-slapping as the person relies more on vision to guide steps. This is why an abnormal gait is the most likely sign in untreated neurosyphilis affecting the dorsal column. Blindness would imply optic nerve involvement, which isn’t the hallmark of tabes dorsalis. Hyperreflexia would suggest upper motor neuron involvement, while tabes dorsalis more commonly presents with reduced reflexes due to dorsal root damage. A stiff neck points to meningeal irritation, not the posterior column degeneration seen in tabes dorsalis.

Tabes dorsalis damages the dorsal columns and dorsal roots, which carry fine touch and proprioception. When proprioceptive feedback is lost, the body can’t sense where the limbs are, so movement becomes uncoordinated and unstable. The characteristic result is a sensory ataxic gait: a wide-based, unsteady walk, often with a positive Romberg sign and foot-slapping as the person relies more on vision to guide steps. This is why an abnormal gait is the most likely sign in untreated neurosyphilis affecting the dorsal column.

Blindness would imply optic nerve involvement, which isn’t the hallmark of tabes dorsalis. Hyperreflexia would suggest upper motor neuron involvement, while tabes dorsalis more commonly presents with reduced reflexes due to dorsal root damage. A stiff neck points to meningeal irritation, not the posterior column degeneration seen in tabes dorsalis.