3例神经梅毒的临床特征分析

目的分析3例神经梅毒的临床特征为早期诊断提供参考。方法回顾性分析3例神经梅毒患者的临床症状、神经影像学和实验室检查特点。结果(1)脑血管梅毒1例,脊髓痨2例;(2)3例血和脑脊液的梅毒抗体均为阳性;脑脊液蛋白含量增加、细胞数增多(以单核细胞为主);(3)脑血管梅毒患者MRA及DSA显示左大脑中动脉M1段闭塞;左大脑前动脉及左大脑后动脉通过皮层支向左大脑中动脉供血区代偿供血;(4)2例脊髓痨患者头颅及胸髓MRI无特殊发现,肌电图及周围神经活检不支持周围神经受损。结论神经梅毒的临床表现与其分型密切相关;首诊易误诊。临床表现及血和脑脊液梅毒抗体阳性是确诊的依据。

Analysis of the clinical features in three cases of neurosyphilis

Objective: To study the clinical features in three cases of neurosyphilis as to offering evidences of early diagnosis.Methods: Clinical feature,neuroimages and laboratory findings of three cases of neurosyphilis were analyzed retrospectively. Results: (1) cerebrovascular syphilis 1 case,tabes dorsalis 2 cases; (2) Inall cases,Serum and cerebrospinal fluid (CSF) syphilis antibody reaction showed positive; CSF protein content was increased significantly,and cells increased(with monocyte mainly) (3) MRA and DSA of cerebrovascular syphilis show that Mi segment of the left middle cerebral artery is blocked. The left posterior cerebral artery and the left anterior cerebral artery compensate blood supply for the left middle cerebral artery through the cortical branch. (4) MRI of head and thoracic cord was normal in 2 cases of tabes dorsalis. Result of EMG and biopsy of sural nerve not manifest damage of peripheral nerveous system. Conclusion: The clinical manifestions of neurosyphilis are closely related to pathological types.Misdiagnosis rate is high at initial reception. Important basis of diagnosis remains on clinical manifestationsand positive syphilis antibody in serum or CSF.