论著神经梅毒的临床特征分析及诊断(附6例报道)王中魁 赵玫 张社卿 丁素菊 【摘要】 目的 分析神经梅毒的临床特征,做到早期诊断和治疗。
方法 回顾性分析经实验室检查确诊的6例神经梅毒患者的有关临床资料。
结果 6例患者中,间质型梅毒3例,实质型梅毒3例,其中1例为脊髓痨,2例为麻痹性痴呆。
6例患者的血、脑脊液梅毒抗体均为阳性,脑脊液蛋白含量增高或正常,细胞数增多,以单核细胞为主。
神经梅毒的磁共振成像检查表现复杂多样,无特异性;间质型梅毒的影像表现为脑梗死、软脑膜增强等;麻痹性痴呆表现为脑萎缩、双侧颞叶及海马区异常信号。
青霉素治疗能明显改善临床症状及预后。
结论 神经梅毒的临床表现多样,易误诊,临床表现和血清、脑脊液梅毒抗体阳性是确诊的依据。
【关键词】 神经梅毒;临床表现;诊断A na lysis of clin i cal fea tur es and di a g n osis o f neur osyphilis :a repo r t o f 6ca ses WA N G Zhongkui ,Z H AO Mei ,Z H A N G S heqing ,D I N G Suj u.D epa rt ment of N eurology ,Cha ngha i H o s pi tal ,Second Milita r y Medical U ni versi ty ,Shanghai 200433,China Cor responding author :D I N G S uju 【Abstra ct 】 Objective To analyze the clinical f eatures of neurosyphilis ,so as to help the early diagno sis a nd treatment.Methods The clinical data of 6patients with confir me d neuro syphilis were retrospectively ana 2lyze d.Results The 6cases included 3inter stitial neurosyphilis and 3substa ntial neurosyphilis ,with 1having ta bes dor salis and 2ha ving ge neral paralysis of insane (GP I ).Patie nts were all positive of syp hilis antibody reac 2tion in ser um and cere brospinal f luid (CSF );CS F p rotein conte nt was incr ea sed or n o rmal and cells increa sed ,mainly monoc ytes.M RI findings of ne urosyphilis were complex ,varied ,and nonspecific.Inter stitial neurosyphi 2lis had a n i mage of cerebral inf arction a nd enhanced sof t me ninge s ;ge neral paresis had a manif esta tio n of brain at rophy and a bnor mal signals of bilate ral temporal lobes a nd hippocamp us region.Penicillin treatment signifi 2cantly improved clinical symptoms a nd p rognosis of neurosyp hilis.Conclusion The clinical ma nife stations of neurosyp hili s are complex and va ried ,ma king it is easy fo r mis 2dia gnosis in clinical work.Dia gnosis ca n be ma de based on clinical manifestations and positive sy philis a ntib ody in ser um or CSF.(Shanghai Med J ,2008,31:7182720)【K ey w or ds 】 Ne urosyphilis ;Clinical manif est atio n ;Diagnosis 作者单位33 上海,第二军医大学附属长海医院神经内科通信作者丁素菊 神经梅毒是梅毒螺旋体侵入神经系统所致,占梅毒患者的10%～25%,其临床表现多样,可见于梅毒感染的任何阶段,易漏诊及误诊。
