梅毒性血管炎致脑卒中7例临床分析  

Clinical Analysis of 7 Stroke Cases Caused by Syphilitic Vasculitis

作　　者：张玉群 黄帆[2] 王立志[2] 李扬[2] 谭双全[2] 

机构地区：[1]广东省韶关市第一人民医院神经内科,韶关512000 [2]中山大学附属第一医院神经科,广州510080

出　　处：《热带医学杂志》2006年第8期930-932,共3页Journal of Tropical Medicine

摘　　要：目的探讨梅毒性血管炎致脑卒中的临床特点。方法分析本院收治的7例梅毒血管炎致脑卒中的临床及检验学、影像学、治疗经过、预后等。结果7例患者全为男性,年龄25～66岁,文化程度大多偏低,均有冶游史,多无明确梅毒感染的全身症状,均为脑血管梅毒。头颅MR表现:基底节、半卵圆中心、放射冠、内囊后肢T1低信号,T2及水抑制T2高信号,桥脑斑片状T2及水抑制T2高信号,枕顶叶条片状T2及水抑制高信号。1例外囊出血,6例血清快速血浆反应素试验(RPR)及全部病例梅毒螺旋血凝试验(TPHA)均阳性。6例做了腰穿,3例脑脊液TPHA阳性。结论梅毒性血管炎以男性多见,尤其是青壮年男性。病例均以中枢神经系统症状起病,梅毒全身症状不明显,容易误诊。试验室及影像学检查是诊断的重要依据。Objective To investigate the clinical characteristics of stroke caused by syphilitic vasculitis. Method Clinical features, laboratory findings, neuroimages, course of treatment and prognosis of 7 stroke patients caused by syphilitic vasculitis were analyzed respectively. Result Seven patients aged 25-66 years, all males with low education level, all had a history of extamarital sexual intercourse. All of them were diagnosed with syphilis of cerebral vessels without definite systematic symptoms of syphilis. Cranial MRI demonstrated abnormalities in multiple areas such as basal ganglia, centrum ovale, corona radiate and posterior limb of internal capsule with lower intensity on T1-weighted scan and high intensity on T2-weighted and FLAIR （fluid-attenuated inversion vecoery） scan. Pons presented plaque-like high intensity areas on T2-weighted and FLAIR scan. Parietal and occipital lobe presented cordlike high intensity areas on T2-weithted and FLAIR scan. 1 case was found hemorrhage of external capsule. In 6 out of 7 cases, the rapid plasma regain （RPR） and treponema pallidum hemagglutination assay （TPHA） test of serum was positive. In 3 out of 6 cases who had lumbar puncture, treponema pallidum hemagglutination assay （TPHA） test of cerebrospinal fluid was positive. Conclusion Male especially young adults were prone to contract syphilitic vasculitis. They all presented with symptoms of central nervous system without obvious definite general symptoms of syphilis, therefore they were usually misdiagnosed. The laboratory and imaging examinations were important diagnostic tools of this disease.

关 键 词：梅毒 血管炎 脑卒中 

分 类 号：R742[医药卫生—神经病学与精神病学]