神经梅毒的临床特征分析及诊断(附6例报道)

目的分析神经梅毒的临床特征,做到早期诊断和治疗。方法回顾性分析经实验室检查确诊的6例神经梅毒患者的有关临床资料。结果6例患者中,间质型梅毒3例,实质型梅毒3例,其中1例为脊髓痨,2例为麻痹性痴呆。6例患者的血、脑脊液梅毒抗体均为阳性,脑脊液蛋白含量增高或正常,细胞数增多,以单核细胞为主。神经梅毒的磁共振成像检查表现复杂多样,无特异性;间质型梅毒的影像表现为脑梗死、软脑膜增强等;麻痹性痴呆表现为脑萎缩、双侧颞叶及海马区异常信号。青霉素治疗能明显改善临床症状及预后。结论神经梅毒的临床表现多样,易误诊,临床表现和血清、脑脊液梅毒抗体阳性是确诊的依据。

Analysis of clinical features and diagnosis of neurosyphilis: a report of 6 cases

Objective To analyze the clinical features of neurosyphilis, so as to help the early diagnosis and treatment. Methods The clinical data of 6 patients with confirmed neurosyphilis were retrospectively analyzed. Results The 6 cases included 3 interstitial neurosyphilis and 3 substantial neurosyphilis, with 1 having tabes dorsalis and 2 having general paralysis of insane (GPI). Patients were all positive of syphilis antibody reaction in serum and cerebrospinal fluid (CSF); CSF protein content was increased or normal and cells increased, mainly monocytes. MRI findings of neurosyphilis were complex, varied, and nonspecific. Interstitial neurosyphi-lis had an image of cerebral infarction and enhanced soft meninges; general paresis had a manifestation of brain atrophy and abnormal signals of bilateral temporal lobes and hippocampus region. Penicillin treatment significantly improved clinical symptoms and prognosis of neurosyphilis.Conclusion The clinical manifestations of neurosyphilis are complex and varied, making it is easy for mis-diagnosis in clinical work. Diagnosis can be made based on clinical manifestations and positive syphilis antibody in serum or CSF.