TN 16 (03-18)
DI 23022.910 Tabes Dorsalis
COMPASSIONATE ALLOWANCE INFORMATION
Progressive Locomotor Ataxia; Locomotor Ataxia; Syphilitic Spinal Sclerosis; Syphilitic Myelopathy
Tabes Dorsalis is a complication of untreated syphilis that damages the spinal cord and peripheral nerves. Symptoms may not appear for many years after the initial infection and include weakness, diminished reflexes, unsteady gait, and loss of coordination, episodes of intense pain and disturbed sensation (paresthesias), personality changes, dementia, deafness, and visual impairment.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Cerebrospinal (CSF) examination, CT/MRI of the head and spine, and serum tests for syphilis infection are required to confirm the diagnosis.
Physical findings: Diagnostic testing along with physical examination may show evidence of damage to the spinal cord and myelopathy with characteristic high stepping “tabetic gait” with loss of coordination and balance, pupils that react abnormally to light, and reduced or absent reflexes.
ONSET AND PROGRESSION
If left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness, as well as affecting other body systems (for example, cardiovascular and musculoskeletal). Treating syphilis with antibiotics cures the infection and prevents new damage, but does not reverse the already present nerve degeneration and other complications.
Physical and occupational therapy may help people who have muscle weakness or muscle wasting. Medications may be needed to treat associated pain.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation:
Clinical history and examination that describes the diagnostic features of the impairment and evidence of damage of the spinal cord and peripheral nervous tissue
Laboratory reports of cerebrospinal fluid
Head CT, spine CT or MRI scans of the brain and spinal cord to rule out other diseases
Suggested Listings for Evaluation:
* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.