以视力损害为首发症状的神经梅毒临床分析  

The clinical characteristics of neurosyphilis initiated with visual impairment

作　　者：于逢春[1] 余华锋[1] 孙彦斌[1] 秦朝晖[1] 王锦鹏 

机构地区：[1]首都医科大学附属北京同仁医院神经内科,100730 [2]河北省献县妇幼保健站

出　　处：《眼科》2005年第6期389-392,共4页Ophthalmology in China

摘　　要：目的 探讨以视力损害为首发症状的神经梅毒的临床特点。设计 病例系列研究。研究对象 7例以视力损 害为首发症状的神经梅毒患者。方法 回顾分析1995年至2005年我科诊治的7例以视力损害为首发症状的神经梅毒患者的 临床、神经影像及实验室资料。 主要指标 视力、视野、眼底及血清、脑脊液的梅毒确诊试验。结果 7例患者均以急性或亚急 性视力下降起病,同时伴视野改变及视乳头水肿。4例患者头颅核磁共振扫描显示视神经信号异常,双侧大脑半球、基底节多发 性缺血灶。所有患者血清和脑脊液快速血浆反应素(RPR)试验及梅毒螺旋体血凝试验(TPHA)阳性。脑脊液蛋白及白细胞轻 度增高,脑脊液髓鞘碱性蛋白(MBP)明显增高。结论 以视力损害为首发症状的神经梅毒临床中少见,且临床特异性不强。梅 毒感染史及血清和脑脊液的梅毒确诊试验有助于诊断。Objective To study the clinical features of neurosyphilis initiated with visual impairment. Design Case series. Participants 7 patients of neurosyphilis initiated with visual impairment. Methods Clinical features, neuronal images and laboratory findings from 7 patients diagnosed from 1995 to 2005 were analyzed retrospectively. Main Outcome Measures Visual acuity, visual field and fundus examination, rapid plasma regain（RPR） and treponema pallidum hem agglutination assay （TPHA） test of both serum and eerebrospinal fluid（CSF）. Results The clinical features of 7 patients showed the initial symptoms of acute or subaeute visual acuity decline and visual field defect. Fundus examination showed papilledema. In 4 patients MRI revealed abnormal signs in optic nerves and multiple asymmetrical isehemie lesions in cerebral hemisphere and basal ganglion. In all patients, the RPR and TPHA test of both serum and CSF samples showed positive. CSF examination revealed increase in protein and leukocyte count. The myelin basle protein （MBP） in CSF was obvious high for all patients. Conclusion The neurosyphilis initiated with visual impairment is rarely, which has no specific clinical manifestations. The infection history of syphilis and the examination of RPR and TPHA both in serum and CSF are important clues for early diagnosis.

关 键 词：神经梅毒 视神经 视乳头水肿 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]