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Tabes dorsalis

Dr Yuranga Weerakkody and Dr Maxime St-Amant et al.

Tabes dorsalis is a form of tertiary neurosyphilis in which there is demyelination of the posterior columns of the spinal cord.

Patients present with symptoms related to dorsal column/nerve-root involvement such as weakness, sensory ataxia (tabetic gait), lancinating pain, hypoesthesia, and other manifestations of neurosyphillis such as personality changes. It has the longest latent period of any neurosyphilis between primary infection and onset of symptoms, averaging about 20 years.

Radiographic features

General

Radiologically, it can manifest as a Charcot joint (neuropathic arthropathy), usually involving either the hip, knee or spine.

MRI

Longitudinal T2W hyperintensity in the dorsal columns of the spinal cord.

Differential diagnosis

General imaging differential considerations include

subacute combined degeneration of the cord (B12 deficiency related myelopathy of the cervical and thoracic cord).

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