General paralysis of the insane is a syndrome of madness and weakness occurring in tertiary syphilis, which is now very rare because of treatment with penicillin.
The signs of this condition are usually those of:
- sudden personality change
- radical alteration of the patient's previous ethical and moral standards
- development of extravagant and grandiose behaviour
- the clinical picture then seems to level out and then is followed by a progressive dementing illness
- there may be an accompanying affective state of flat euphoria
- the patient may have Argyll-Robertson pupils
- CSF pressure is often slightly raised
- microscopy shows an excess of mononuclear cells and protein with a marked increase in globulin fraction
- serology is always positive
Death usually occurs within three years.