16例麻痹性痴呆患者的临床分析  

Clinical analysis of 16 cases of general paresis

作　　者：徐淑兰[1] 张丽[1] 

机构地区：[1]南京医科大学附属脑科医院老年神经科,江苏省南京市210029

出　　处：《实用老年医学》2013年第2期132-134,共3页Practical Geriatrics

摘　　要：目的分析16例麻痹性痴呆患者的临床特征,为临床早期诊断麻痹性痴呆提供线索。方法回顾性分析16例麻痹性痴呆患者的临床资料。结果麻痹性痴呆的临床特点包括:(1)男性较女性多见,多急性起病;(2)临床主要表现为进行性智能障碍,伴明显的精神异常;(3)脑脊液表现:蛋白升高,白细胞数升高,以淋巴细胞为主;(4)梅毒血清学试验:血清:快速血浆反应素试验(RPR)及血清梅毒螺旋体明胶凝集试验(TPPA)均为阳性,脑脊液:RPR试验有14例阳性,TPPA试验均阳性;(5)头颅CT、头颅MR多表现为脑萎缩、对称性的脑室扩大;(6)经足疗程的青霉素治疗后,患者的临床症状在短期内均得到不同程度的改善。结论麻痹性痴呆早期误诊率高,对高危患者要及早进行血清学和脑脊液梅毒筛查试验,以早期诊断、早期治疗,改善预后。足量的青霉素疗效较好。Objective To study the clinical features of general paresis of insane in 16 patients for earlier diagnosis. Methods The clinical features,laboratory findings and EEG examinations,neuroimages and prognoses of 16 cases of neurosyphilis were analyzed retrospectively. Results General paresis of insane were more common in male than female. The main clinical manifestations were impaired memory and psychosis. The cerebrospinal fluid (CSF) examination demonstrated as elevated protein, pleocytosis as lymphocytes predominated. Fourteen cases showed positive results in serum and CSF RPR and TPPA test. Twelve cases (75%) presented with brain atrophy with symmetrical enlargement of brain ventricles. With adequate penicillin treatment, symptoms were reversed to some extents in short time. Conclusions Paralytic dementia has high misdiagnosis rate. Serum tests and CSF syphilis antibody tests should be performed in the patients who are suspected to suffer from neurosyphilis. Sufficient penicillin has an accurate treatment effect.

关 键 词：神经梅毒 麻痹性痴呆 临床分析 

分 类 号：R749.16[医药卫生—神经病学与精神病学]