麻痹性痴呆二例的临床特征与诊断

目的分析麻痹性痴呆(GPI)的临床特征及提供早期诊断依据。方法回顾性分析经临床和实验室检查确诊的2例麻痹性痴呆患者的有关临床资料。结果GPI的临床特征(1) 2例患者慢性起病,进行性发展; (2)痴呆是核心症状, 2例患者入院时长谷川痴呆量表评分为4分和17分,均伴夸大妄想、病理性欣快等精神症状; (3) 1例患者的瞳孔左右不等大,光反射迟钝或消失但辐辏反射保持, 2例患者均有构音障碍、肌张力增高及反射异常等; (4) 2例患者血清、脑脊液梅毒抗体反应均为阳性,脑脊液蛋白含量增加、细胞数增多(以淋巴细胞为主); (5)头颅MRI示2例患者均有脑萎缩, 1例患者有脑实质异常信号影,为多发、散在病灶,广泛脑白质纤维变性。结论GPI误诊率高,临床表现、实验室及影像学检查是诊断的重要依据。

Clinical features and diagnosis in two cases general paresis of insane

Objective To analyse the clinical features in general paresis of insane(GPI)as to offering an early diagnosis. Methods A retrospective analysis of 2 cases of GPI was focused on their clinical manifestations. Results The clinical features of GPI showed: (1) Chronic onset, progressive development in 2 cases; (2) Dementia was key symptom.Hasegawa dementia scales were 4 and 17 in 2 cases.2 cases accompanied with abnormal mentality,such as delusion of grandeur ,euphoria and so on;(3)GPI have features of pupil change,dysarthria,muscular tension,abnormal reflection; (4) Serum and cerebrospinal fluid (CSF) syphilis antibody reaction manifested positive, CSF protein content was increased significantly, and cells increased ( with lymph cell mainly ); (5) Head MRI manifested: cerebral atrophy in 2 cases, multiple abnormal signals in cerebral parenchyma in 1 case. Conclusions GPI misdiagnosis rate is high. Important basis of diagnosis remains on clinical manifestations, laboratory and imaging examinations.