脑膜血管型神经梅毒的临床分析  

Analysis of clinical characteristics and prognosis of meningovascular syphilis

作　　者：田玲[1] 刘文华[1] 肖露露[1] 张海侠[1] 曹琴琴[1] 陈昕[1] 戴敏慧 徐格林[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)神经内科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2016年第2期178-181,共4页Journal of Medical Postgraduates

摘　　要：目的脑膜血管型梅毒是梅毒螺旋体感染引起的脑膜及脑实质内血管的梅毒性动脉内膜炎,可致局部缺血和梗死。文中探讨脑膜血管型神经梅毒的临床、影像学特点和预后转归,以期为提高神经梅毒的诊断和治疗水平提供参考。方法收集南京军区南京总医院2007年12月至2015年3月确诊的14例脑膜血管型神经梅毒患者的临床和影像学资料,并完成对患者10.2-37.9个月的随访,记录患者预后。结果脑膜血管型神经梅毒主要以眩晕、偏瘫、偏身感觉障碍、认知功能减退等起病,影像学表现主要为病灶散在多发,头颅CTA/MRA可见颅内血管狭窄。实验室检查有特征性改变,其中脑脊液蛋白浓度9例升高,葡萄糖4例偏高。经大剂量足疗程驱梅治疗后,脑膜血管型神经梅毒3个月预后良好者（改良Rankin量表≤2分）达78.57%,长期预后良好者达85.71%。结论脑膜血管型神经梅毒影像学病灶散在多发无特异性,大多数患者经足量全程的青霉素治疗后预后良好。Objective Meningovascular syphilis is the intima inflammation of blood vessels caused by the syphilitic infection,which is associated with the occurrence of ischemic stroke. The study analyzed the clinical,imaging features and prognosis for meningovascular syphilis so as to improve its diagnosis and treatment. Methods 14 patients diagnosed with meningovascular syphilis were collected prospectively from December 2007 to March 2015 in the neurological department of Jinling Hospital. The patients were followed for a period of 21. 5（ range 10. 2 - 37. 9） months,and the prognosis were evaluated. Results Patients with meningovascular syphilis presented with dizziness,hemiplegia,hemidysesthesia and cognitive decline. Lesions showed multiple,scattered on MR imaging,intracranial vascular stenosis was seen in the CTA / MRA,and the laboratory examination had characteristic changes. With a large dose and sufficient courses of penicillin treatment,meningovascular syphilis may hopefully get predominant effects. 78. 57% patients got good prognosis（ modified Rankin Scale,mRS ≤2） at 3 months and 85. 71% patients got goodlong-term prognosis（ mRS ≤2）.Conclusion Meningovascular syphilis was usually presented as acute onset,lacks the specific clinical and neuroimaging manifestations. Most patients has favourable prognosis after treatment of syphilis with full course of penicillin.

关 键 词：脑膜血管型梅毒 临床特点 预后 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]