以癫痫症状首诊的神经梅毒1例及文献复习  

One Case of Neurosyphilis Presenting Epilepsy and Literature Review

作　　者：梁文 晏洪波 LIANG Wen;YAN Hongbo(Department of Dermatology,General Hospital of Central Theater Command,Wuhan Hubei 430070,China)

机构地区：[1]中部战区总医院皮肤科

出　　处：《华南国防医学杂志》2019年第10期700-703,共4页Military Medical Journal of South China

摘　　要：目的探讨神经梅毒患者的临床特征、发病机理、诊断、实验室检查以及治疗。方法报道1例以癫痫为首发症状的神经梅毒患者,进行血清和脑脊液梅毒螺旋体颗粒凝集试验(Treponema pallidum particle agglutination test,TPPA)、快速血浆反应素环状卡片试验(rapid plasma reagin circle card test,RPR)、脑脊液生化检查、脑电图和核磁共振检查,予以正规足量驱梅治疗,并复习相关文献。结果本例神经梅毒以癫痫症状就诊,血清RPR(-),比较特殊,经过驱梅治疗后症状缓解。结论神经梅毒因其临床表现的多样性、实验室化验结果的复杂性极易误诊,建议对有癫痫症状的患者,特别是有其他不明原因的神经症状的患者,应进行梅毒血清学和脑脊液检查,以确定是否存在神经性梅毒,避免延误治疗。同时即使血清RPR筛查阴性,也不能排除神经梅毒。Objective To explore the clinical features,diagnosis,differential diagnosis,laboratory test and treatment of neurosyphilis.Methods A case of neurosyphilis with epilepsy as the first symptom was reported. The Treponema pallidum particle agglutination test(TPPA),rapid plasma reagin circle card test(RPR), cerebrospinal fluid biochemical examination, electroencephalogram and nuclear magnetic resonance examination were performed,then the regular and adequate treatment to drive syphilis were implemented.And the relevant studies were reviewed.Results This case of neurosyphilis presented with epilepsy,serum RPR was negative, which was very special.The symptoms were relieved after treatment.Conclusion Neurosyphilis is easily misdiagnosed due to its diversity of clinical manifestations and complexity of laboratory test results. It is suggested that serological and cerebrospinal fluid tests should be performed for patients with neurological symptoms of unknown causes. It determines whether neurosyphilis exists,and avoids delayed treatment. Neurosyphilis cannot be ruled out even if serum RPR screening is negative.

关 键 词：神经梅毒 癫痫 临床特征 诊断 治疗 

分 类 号：R759.13[医药卫生—皮肤病学与性病学]