Tabes dorsalis in neurosyphilis presents with which combination of symptoms?

• A. Hemiparesis and hyperreflexia
• B. Seizures and aphasia
• C. Cranial nerve palsy with diplopia
• D. Ataxia with areflexia and burning pain

Answer: (D)

Tabes dorsalis is a late manifestation of neurosyphilis due to degeneration of the dorsal columns and dorsal roots. This disrupts deep sensation, so proprioception and vibration are lost, leading to a wide-based, unsteady gait that worsens with eyes closed (positive Romberg) and a characteristic sensory ataxia. In addition, dorsal root involvement causes lancinating, burning pains in the limbs, often described as lightning-like. The combination of ataxia, areflexia, and neuropathic pain is classic for tabes dorsalis.

Other patterns, like hemiparesis with hyperreflexia, seizures with aphasia, or cranial nerve palsy with diplopia, point to motor, cortical, or brainstem processes rather than the dorsal column–dorsal root degeneration seen in tabes dorsalis.