摘要
目的总结神经梅毒的临床及影像学特点。方法收集宣武医院2000-2012年诊断明确的神经梅毒患者,对其临床和影像学资料进行回顾性分析。结果共收集18例患者,男15例,女3例;年龄30～62岁,平均49.03岁;病程34d～2年,平均9.43个月。其中麻痹性痴呆7例,脊髓痨4例,脑膜血管梅毒3例,周围神经病2例,视神经病变1例,颅神经麻痹1例;6例同时合并存在多种类型的神经梅毒感染。所有患者均进行了腰穿脑脊液检查,脑脊液白细胞数为5～190×106/L,细胞学均为以淋巴细胞为主的炎症,脑脊液生化检查示蛋白不同程度的升高(450～2120mg/L)。所有患者血清及脑脊液梅毒抗体均为阳性。7例麻痹性痴呆患者头颅MRI示不同程度脑萎缩,4例表现为海马和(或)颞叶异常信号。结论神经系统梅毒感染可累及神经系统多个部位,临床症状复杂,脑脊液细胞数和蛋白增多,对于临床上疑诊为神经梅毒的患者,进行血清和脑脊液梅毒检测是必要的。
Objective To improve the recognition of neurosyphilis by analyzing the clinical and image features of neurosyphilis patients. Methods The clinical presentations and MR/of 18 patients with neurosyphilis were retrospectively reviewed. Results Eighteen cases with neurosyphilis were collected. Their ages ranged from 30 to 62 years, with a mean age of 49.03. The types of neurosyphilis included general paresis in 7 eases, tabes dorsalis in 4 cases, eerebrovascular neurosyphilis in 3 cases, peripheral nerve impairment in 2 cases, optic neuropathy in 1 case, and cranial nerve palsy in 1 case. Intelligence disturbance, psychiatric symptoms, epilepsy, ataxia and visual disturbance were the common syndromes. MRI was performed in all 7 cases with general paresis of neurosyphilis. Remarkable cerebral atrophy was found in 2 cases. High signal intensity on T2-weighted images and FLAIR involving frontotemporal lobe and hippocampus were found in 4 cases. Lumber puncture were performed in all cases and most patients had lymphocytic, monocytic pleocytosis and high protein levels in their CSF. The results of rapid plasma regain test （RPR） and treponema pallidum hemagglutination assay （TPHA） were positive in cerebrospinal fluid （CSF） and the serum in all patients. Conclusion Clinical features, MRI find- ings and the CSF examination are valuable for the diagnosis of neurosyphilis.
出处
《北京医学》
CAS
2013年第5期327-328,332,共3页
Beijing Medical Journal
关键词
神经梅毒
临床症状
影像学
Neurosyphilis Clinical presentation Imaging
