The main signs of spinal consumption, one of the manifestations of spinal syphilis, are loss of knee and ankle reflexes, impaired vibration and position sensation in the lower extremities, and a positive closed-eye refractory sign. The central infection of syphilis begins with syphilitic meningitis (about 1/4 of all syphilitic infections), a large proportion of which is asymptomatic meningitis that can only be detected by lumbar puncture, and a small proportion of which manifests as a more severe meningitis dominated by cerebral nerve palsy, epilepsy, and increased intracranial pressure. Syphilitic meningitis can go through an asymptomatic phase for several years before eventually entering a phase of brain or spinal cord parenchymal involvement, which includes meningeal vascular syphilis, paralytic dementia, spinal consumption, and syphilitic spinal myelitis. How do you check for impaired vibration and position sensation in the lower extremities? The main symptoms are lightning-like pain, sensory ataxia and urinary incontinence, and the main signs are loss of knee and ankle reflexes, impaired vibration and position sense in the lower limbs, and positive closed-eye difficulty sign. More than 90% of the patients have pupillary abnormalities, which are usually characterized as a-lo pupils, i.e., bilateral pupils that are unequal in size, narrow and irregular, with loss of light reflexes but presence of adjustment reflexes. Most patients have drooping lids and varying degrees of ocular muscle paralysis, and optic nerve atrophy is also common. More than 90% of patients have lightning-like pain, mostly in the lower extremities, but also from the face to the lower extremities, the pain is sharp and brief, lightning-like, knife-like, tear-like, burning-like, etc. Occasionally, the pain may persist in a certain place. Ataxia is caused solely by deep sensory impairment, and the gait is staggering when walking, with a cross-threshold gait (the lower limbs are excessively elevated when walking, stepping harder, and the size of each stride varies), and in advanced stages, it is difficult to walk even if the muscle strength is intact. 3, sphincter dysfunction Due to the posterior root lesion of lumbar segment 2 to 4, it affects bladder sensation, and the bladder fills up without the intention to urinate, forming urinary retention and filling incontinence. 4, visceral crisis Gastric crisis is the most common, manifested as sudden epigastric pain, and can extend to the chest, chest contraction, can be accompanied by nausea, vomiting, vomiting often repeated until vomiting bile, after the attack, the patient is often exhausted and feel the epigastric skin soreness. In small bowel crisis, colic and diarrhea are present; in pharyngeal and laryngeal crisis, swallowing movements and dyspnea attacks are present; in rectal crisis, urgency is present; in genitourinary crisis, pain and difficulty in urination are present. With the exception of gastric crisis, all other crises are rare. Syphilitic spinal myelitis and spinal membranous vascular syphilis often develop 3 to 5 years after syphilis infection. Syphilitic spinal myelitis is also known as Erb’s spastic paraplegia because its clinical manifestations are dominated by bilateral corticospinal tract damage; in some cases where the spinal membranes are predominantly involved, it often manifests as radicular pain in the neck, shoulders, and upper extremities, muscle atrophy, and long tract signs in the lower extremities due to spinal membrane thickening, adhesions, and compression of nerve roots and spinal cord. Meningeal vascular syphilis of the spinal cord is mainly vascular involvement, often due to endarteritis and spinal vascular thrombosis, with rapid onset and symptoms depending on the extent of innervation of the involved vessels.