The initial lesion of syphilis must be viewed, in the light of our present knowledge, as a wound plus infection, the infecting material being probably of bacterial origin.
The first nervous changes following such infection are localized at the sight of the initial lesion, and have been well described by Berkley.1 Briefly, these changes consist of a combined interstitial and parenchymatous neuritis, due, in the investigator's opinion, to, 1, compression by the round-celled exudate; 2, endarteritis, interfering with nutrition; 3. local effect of a "virus."
The conditions found in the nerves are described as, 1, obliteration of lymph spaces; 2, disappearance of axons; 3, a "glassy" degenerated appearance of the myelin.
These changes were limited to the nerves imbedded in the round-celled exudate; those nerves not so surrounded being normal, or approximately so. Root-neuritis, cranial and spinal, and peripheral mono-neuritis may occur as secondary lesions.
Syphilitic multiple neuritis has
LANGDON FW. SYPHILIS OF THE NERVOUS SYSTEM—ITS GENERAL PATHOLOGY, WITH REMARKS ON TREATMENT.. JAMA. 1901;XXXVII(17):1105–1110. doi:10.1001/jama.1901.62470430029001g