麻痹性痴呆36例临床分析

目的 总结麻痹性痴呆(GPI)临床特征,探讨其治疗及预后.方法 回顾分析2004年1月～2006年3月在我院经临床和实验室检查确诊的麻痹性痴呆患者36例.结果 25例(69.4%)以慢性进行性痴呆为主要表现;10例(27.8%)以精神错乱为主要表现;1例(2.8%)以癫痫发作为突出症状.误诊率高达33.3%.86.1%头颅MRI异常,异常者存在脑萎缩,其中额叶、颞叶、顶叶及皮层下白质的萎缩多见;25.8%合并有脑积水,25.8%存在梗死病灶;13.9%头颅MRI正常.用大剂量青霉素治疗后,全部病例临床症状都得到改善.结论 GPI临床表现多样,易误诊;脑萎缩是GPI主要特点,部分合并有脑积水、缺血病灶;大剂量青霉素治疗有效.

Clinical analysis on 36 cases of general paresis of insane

Objective To summarize the clinical feature of general paresis of insane(GPI) and explore its treatment and prognosis.Methods A retrospective analysis of 36 cases with GPI were conducted focusing on their clinical manifestations.Results Chronic and progressive dementia served as main manisfestation in 25 cases(69.4%).Mental disorder was chief symptom in 10 cases(27.8%).Epileptic attack was outstanding symptom in 1 case.The misdiagnosis rate is 33.3%.31(86.1%) patients show abnormality in MRI.Most of them have atrophy in frontal lobe,temporal lobe),apical lobe,and substantia alba.8(25.8%) cases show dropsy of head,8(25.8%) cases are combined with infarction.13.9% cases show normality in MRI.Clinical symptoms of 36 cases had improved.Conclusion The symptoms of GPI are varied,and liable to be misdiagnosed.Cerebral atrophy is important characteristic of GPI.Some of them are combined with hydrencephalus and ischemic lesions.It is effcetive to treat it with massive dose of penicillin G.