树胶肿型神经梅毒七例临床分析  

Clinical characteristics of cerebral syphilitic gumma

作　　者：高俊华[1] 李务荣[1] 伍文清[1] 许东梅[1] 黄宇明[1] 王芳[2] 

机构地区：[1]首都医科大学附属北京地坛医院神经内科,100015 [2]首都医科大学附属北京地坛医院神经外科,100015

出　　处：《中华全科医师杂志》2017年第8期614-617,共4页Chinese Journal of General Practitioners

摘　　要：目的 探讨树胶肿型神经梅毒的临床特点.方法 回顾性分析2012年6月至2016年10月于首都医科大学附属北京地坛医院诊断的7例树胶肿型神经梅毒患者的临床特点、影像学及预后.结果 7例患者中,女性5例,男性2例.以头痛起病5例,脑脊液白细胞数增高6例,脑脊液蛋白增高6例.7例患者共有病灶10处,其中脑叶病灶7处,3处分别位于小脑、胼胝体及脚间池.5例患者头颅MRI显示病灶呈结节样强化,2例呈环形不规则强化.6例患者病灶周围明显水肿.普通青霉素400万U、每4小时1次静脉滴注、连续2周,序贯长效青霉素240万U、每周1次肌肉注射、连续3周.疗程结束后复查,症状部分改善1例,完全改善5例,影像学均明显好转;1例死亡.结论 树胶肿型神经梅毒多以头痛起病,病灶多位于脑叶,以结节样增强为主,治疗后大部分病例预后良好.Objective To analyze the clinical characteristics of cerebral syphilitic gunma.Method The clinical characteristics,brain CT and MRI results and prognosis of 7 patients with cerebral syphilitic gumma admitted in Beijing Ditan Hospital from June 2012 to October 2016 were retrospectively analyzed.Results There were 5 females and 2 males in 7 patients.The symptoms or signs at onset were headache （n =5）,increased white blood cells in cerebrospinal fluid （n =6） and increased protein contents in cerebrospinal fluid （n =6）.Total 10 lesions were detected in 7 cases,including 7 in cerebral lobe,and 3 in cerebellum,corpus callosum or intercrural space.The brain MRI showed nodular reinforcement in 5 cases,irregular circular reinforcement in 2 cases and obvious edema around the lesions in 6 cases.The patients were given intravenous infusion of 400 million units common penicillin,q.4h for 2 wks,sequential intramuscular injection of 240 million units long-term penicillin q.w for 3 wks.Among 7 patients,1 case died,1 case showed symptomatic improvement and 5 cases obtained complete improvement with the significant imaging improvement.Conclusion Headache is the most common symptom at onset of cerebral syphilitic gumma,and the lesions mostly are located in the cerebral lobes with nodular enhancement in brain imaging,and the prognosis is generally good.

关 键 词：神经梅毒 病理状态 体征和症状 磁共振成像 

分 类 号：R759.13[医药卫生—皮肤病学与性病学]