Acute Encephalopathy and Arseno-Therapy of Syphilis

Acute hamorrhagic encephalitis or encephalopathy is, perhaps, one of the most dreaded of complications which can occur during arsenotherapy of syphilis. Before the introduction of intensive arsenotherapy by Chargin and others (1935), the incidence of this condition was almost negligible; according to Harrison (1939), only 8 cases were reported from 800,000 injections during the war of 1914-18. Since the popularization of intensive arsenotherapy during the world war 1939-45, however, the incidence of encephalopathy has increased considerably. Its incidence varies according to different workers: thus Young and Gordon (1944) report 5 fatalities from acute encephalopathy following about 10,000 injections at an East African Centre, the drug used being neoarsphenamine, 0-6 g. twice weekly, in addition to 2 weekly injections of bismuth metal of 0 1 g. each. Lydon (1944) reports that 5 out of 53 patients developed the condition during treatment by a short-term intensive course of mapharside; one of his patients died. Pillsbury and others (1944) state that the reaction of encephalopathy did not occur frequently during intensive arsenotherapy by a modified 20-day treatment. Lloyd Jones and Maitland (1945) report 3 cases out of a total of 241 (?) patients treated by a modified course of intensive arsenotherapy. According to McDonagh (1920), the condition develops some 48 to 72 hours after the second or third injection. Pillsbury and others, quoting U.S.A. Army circular letter No. 138 on intensive therapy for early syphilis, say that it is characterized by " mild to severe mental confusion, headaches, fever, convulsive seizures, and in some cases coma. Spinal fluio sometimes shows marked increase in protein." The treatment most generally adopted is venesection, lumbar puncture, intravenous hypertonic glucose, and the administration of adrenaline or benzedrine, but the results of treatment have varied (McDonagh, 1920; Young and Gordon 1944; Lydon, 1944). The use of thiosulphate, intravenously has also been advocated (Sheppe, 1930). Lydon (1944) brings out several points of interest and importance which do not appear to have been noted by other workers. In his series of cases he observed that the primary signs of encephalopathy occurred in themental sphere, either as a sudden explosive onset of acute apprehension and fear, or as a general slowing of cerebration. The resemblance of these mental changes to those of the two types of alcoholism led to a tentative suggestion that perhaps a similar pathological condition was present and that the condition might be avoided or improved upon the exhibition of vitamin B1. Alcoholism is suggested as a predisposing factor. Upon this hypothesis vitamin B1 was administered in the later cases of the series quoted, with apparently marked benefit. The following case is of interest in the light of Lydon's observations.