麻痹性痴呆7例诊治分析  

Clinical analysis on 7 cases of dementia paralytica

作　　者：郭咏萍[1] 蒋晓江[1] 高东[1] 周红杰[1] 王景周[1] 李玮[1] 

机构地区：[1]第三军医大学第三附属医院野战外科研究神经内科三病区,重庆400042

出　　处：《现代医药卫生》2010年第4期485-486,共2页Journal of Modern Medicine & Health

摘　　要：目的:总结麻痹性痴呆的诊治体会。方法:回顾性分析我科7例麻痹性痴呆确诊患者临床的诊治及疗效。结果:7例患者均出现认知功能损害,人格改变及痴呆。5例MRI脑部检查发现弥漫性皮质及皮质下萎缩。所有患者血浆反应素试验(RPR)、梅毒螺旋体血凝试验(TPPA)、脑脊液TPPA均阳性。脑脊液蛋白升高,5例出现白细胞升高。确诊麻痹性痴呆后给予2周青霉素强化治疗,随访(6.9±0.6)个月,3例出现症状改善,4例无明显改善,社会行为功能较差。结论:麻痹性痴呆缺乏典型临床症状特征,早期诊断困难。临床需提高对麻痹性痴呆的警惕。Objection：To analyze the treatment of dementia paralytica.Methods：Seven patients with dementia paralytica were diagnosed and comfirmed between May 2000 and March 2006 in our department.The data of clinical presentation and outcomes were analyzed retrospectively.Results：7 patients developed cognitive deterioration,personality change and dementia.Five of the 7 patients had MRI findings of atrophy of the diffuse cortical and subcortical atrophy.The rapid plasma reagin titer（RPR） and treponema pallidum particle agglutination（TPPA） in serum and cerebrospinal fluid were positive.The cerebrospinal fluid protein increased in 7 cases and white cell count increased in 5 case of all the cases.When dementia paralytica was diagnosed,a 2-week course of intensive treatment with penicillin G was started.At a mean follow up of（6.9±0.6） months,3 of 7 had variable improvement.A general dementia remained even after the treatment was completed in other four patients,and outcome in social functioning was poor.Conclusion：Dementia paralytica may lack typical clinically characteristic symptoms,leading to early diagnostic difficulties.Clinicians should alert the possibility of patients with dementia paralytica.

关 键 词：麻痹性痴呆 神经梅毒 苍白密螺旋体 诊断 

分 类 号：R9[医药卫生—药学]