Bladder dysfunction, which can result in failure to store or empty urine, or a combination of the two, affects approximately 75% of patients. In 15%, symptoms are severe enough to prevent the patients from leaving home or attending social activities. Demyelinating lesions above the level of the pons may result in detrusor hyperreflexia with uninhibited bladder contractions, which causes urinary urgency that is often accompanied by frequency, frequency, nocturia, and urge incontinence. Lesions involving the reticulospinal pathways above S2 and below the pons may also lead to involuntary bladder contractions or cause simultaneous contraction of the bladder wall and urethra, a condition c ondition known as detrusor-sphincter dyssynergia. Patients with detrusor-sphincter dyssynergia have storage and emptying dysfunction and a combination of urgency urgency,, frequency, frequency, difficulty initiating voiding, incomplete emptying, and incontinence. Damage to the upper urinary tract and kidneys as a result of increased intravesicular pressure is rare. Hypocontractility and failure of the bladder to empty properly occurs with demyelination of the lower sacral anterior horn cells. Complete inability to void is uncommon.
! Caused by syphilis
! Syphilis causes a selective destruction of nerve fibers at the point of entrance of the posterior root into the spinal cord, especially in the lower thoracic and lumbosacral regions.
! Symptoms and signs that may be present:
! Stabbing pains in the lower limbs, which may be very severe
! Paresthesia, with numbness in the lower limbs ! Hypersensitivity of skin to touch, heat, and cold ! Loss of sensation in the skin of parts of the trunk and lower limbs and loss of awareness that the urinary bladder is full ! Loss of appreciation of posture or passive movements of the limbs, especially the legs;
! Loss of deep pain sensation, such as when the muscles are forcibly compressed or when the tendo achillis is compressed between the finger and thumb ! Loss of pain sensation in the skin in certain areas of the body, such as the side of the nose or the medial border of the forearm, the thoracic wall between the nipples, or the lateral border of the leg ! Ataxia of the lower limbs as the result of loss of proprioceptive s ensibility (the unsteadiness in gait is compensated to some extent by vision; however, in the dark or if the eyes are closed, the ataxia becomes worse and the person may fall) ! Hypotonia as the result of loss of proprioceptive information that arises from the muscles and joints ! Loss of tendon reflexes, owing to degeneration of the afferent fiber component of the reflex arc (the knee and ankle tendon jerks are lost early in the disease).
The mesial temporal lobe is, as the name suggests, located on the medial aspect of the temporal lobe and is distinct from the rest of the lobe which is comprised of neocortex. The term encompasses five structures: 1 amygdala 2 hippocampus 3 uncus 4 dentate gyrus 5 parahippocampal gyrus
