15例晚期神经梅毒的临床表现和实验室检查分析  

Clinical presentations and laboratory examination of late neurosyphilis

作　　者：王锁彬[1] 贾建平[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中风与神经疾病杂志》2011年第8期739-741,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析晚期神经梅毒的临床特点及实验室检查。方法回顾15例晚期神经梅毒患者的临床特点、血清及脑脊液检查和神经影像学改变。结果患者年龄33～62岁,平均47.7岁;分为麻痹性痴呆8例,脊髓痨3例,视神经萎缩1例,混合型3例。误诊率高达86.7%,多误诊为病毒性脑炎、精神病、糖尿病性脊髓痨、亚急性联合变性等。起病隐袭,缓慢进展,病程相对较长,具有阿-罗氏瞳孔,可能是麻痹性痴呆与病毒性脑炎的鉴别点;双下肢或下腹部的针刺样或剧烈的闪电样疼痛,并伴有尿便失禁,可能是脊髓痨的重要特点。CSF白细胞数增加、蛋白和IgG水平均明显高于正常。麻痹性痴呆的MRI多表现为额颞叶,特别是颞叶内侧、岛叶的异常,在T2加权和FLAIR相上为高信号,并可见脑皮质萎缩,脑室不同程度扩大,海马萎缩;脊髓痨患者,脊髓MRI可以无明显改变。结论晚期神经梅毒患者具有一些较特征性的临床表现,而脑脊液白细胞计数、蛋白和IgG水平测定、神经影像学检查对诊断具有重要价值。Objective To analyze the clinical characteristics and laboratory examination of late neurosyphilis.Methods The clinical presentations,laboratory findings in their blood and cerebrospinal fluid（CSF）,and findings in MRI among 15 patients with late neurosyphilis were reviewed.Results The ages of patients were between 33 and 62 years（average 47.7 years）.The patients showed general paresis（8 cases）,tabes dorsalis（3 cases）,optic atrophy（1 cases） and combined forms of neurosyphilis（3 cases）.Misdiagnosis occurred in 86.7%of the patients with late neurosyphilis,most frequently as viral encephalitis,psychosis,pseudotabes diabetic,subacute combined degeneration.General paresis had a insidious onset and Argyll Robertson pupils,with more chronic and longer course than viral encephalitis.Tabes dorsalis had prickling-like or lightning pain in lower extremities or hypogastric region,with urinary and fecal incontinence.Leukocyte counts and protein/IgG levels in CSF were increased.MRI of general paresis showed high signal intensity on T2-weighted images in frontotemporal lobes,and cerebral atrophy.Conclusion Chracteristic clinical features,leukocyte counts and protein/IgG levels in CSF and MRI findings are valuable in the diagnosis of late neurosyphilis.

关 键 词：神经梅毒 麻痹性痴呆 脊髓痨 脑脊液 磁共振显像 

分 类 号：R759.13[医药卫生—皮肤病学与性病学]