Charcot’s triad: what is it?

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Charcot’s triad refers to three sets of symptoms that characterize a pair of diseases. Charcot’s neurological triad, consisting of nystagmus, intention tremor, and staccato or scanned speech, indicates a diagnosis of multiple sclerosis. Alternatively, when discussing gastrointestinal disease, Charcot’s triad refers to the combination of right upper quadrant abdominal pain, fever, and jaundice. In these cases, Charcot’s triad increases the likelihood that the patient has cholangitis, an infection of the bile ducts. No triad, however, invariably warrants the diagnosis, as other diseases can produce the same symptoms.

Multiple sclerosis is a progressive, degenerative neurological disease in which the myelin sheaths that normally surround and insulate nerves begin to break down. Nerves cannot transmit electrical impulses properly without the normal myelin sheath. Symptoms of Charcot’s triad occur due to myelin degeneration. Nystagmus is a jerky, rhythmic, involuntary eye movement, while intention tremor is a tremor that intensifies when the patient deliberately tries to use an extremity. Statta speech is speech in which each syllable is enunciated separately, while scan speech is slurred and droning in quality.

Bile is a body fluid produced by the liver that aids in digestion. Cholangitis is an infection of the duct or tube that carries bile to the gallbladder and intestines. If the bile duct becomes blocked by gallstones, tumor, or scar tissue, the bacteria can cause an infection in the duct, which can later spread to the liver. Jaundice, which is a yellowish discoloration of the skin and eyes, occurs when the normal excretion of bile is blocked. Fever and right upper quadrant pain occur when the infection develops in the liver and bile duct, which are located in the right upper abdomen. As the patient becomes sicker, hypotension and mental status changes combine with Charcot’s triad to form Reynold’s pentad.

Both forms of Charcot’s triad are named after Jean-Martin Charcot, a French neurologist who is widely considered the creator of modern neurology. One of Charcot’s major contributions to medical science was his advancement of methodical neurological assessment and the correlation of clinical findings with specific disease entities. Charcot’s name is associated with many other medical terms and designations, including Charcot-Bouchard aneurysms, Charcot-Marie-Tooth disease, and Charcot disease, also known as amyotrophic lateral sclerosis or Lou Gehrig’s disease. Charcot also first described the Charcot joint, which is a weight-bearing joint that has degenerated due to loss of sensation of the peripheral nerves.

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