以脑梗死表现的3例神经梅毒病例分析

目的分析3例被误诊为急性脑梗死接受溶栓治疗的神经梅毒患者的临床资料,提高对神经梅毒的诊断准确率,降低基层医院溶栓误治率。方法回顾性总结收治的3例以急性脑梗死起病并给以rt-PA静脉溶栓治疗神经梅毒患者的临床症状、实验室检查、脑电图及影像学检查结果、诊治过程及预后等资料,采用NIHSS评分进行神经功能评估,m RS评分进行预后评估。结合文献分析以急性脑梗死起病的神经梅毒的临床特征。结果3例以急性脑梗死起病的男性患者,接受rt-PA静脉溶栓治疗,神经功能缺损症状恶化,以往无脑血管病危险因素,影像学检查提示脑缺血和脑萎缩,血及脑脊液梅毒螺旋体明胶凝集试验和甲苯胺红不加热血清学试验阳性明确神经梅毒诊断。早期、大剂量、足疗程青霉素G治疗预后良好,NIHSS及m RS评分降低。结论以急性脑梗死起病的神经梅毒患者,静脉溶栓治疗效果差,尽早进行梅毒血清学和脑脊液检查,降低溶栓误治率,大剂量青霉素G治疗有效。

Clinical Analysis of Three Neurosyphilis Patients Misdiagnosed as Cerebral Infarction Thrombolytic Therapy

Aim To analyze the clinical features, laboratory ifndings, electroencephalography (EEG) and neuroimaging of neurosyphilis presented with acute cerebral infarction as the principal manifestation to improve the diagnosis of neurosyphilis and reduce the mistreatment rate of thrombolysis patients in basic hospital.Methods Three meningovascular neurosyphilis patients with acute cerebral infarction were given intravenous thrombolytic therapy of rt-PA injection. The clinical manifestation, laboratory examinations, neuroimaging examinations, diagnosis and treatment outcomes were retrospectively analyzed. The short and long term prognosis with the NIHSS and mRS were assessed.Results Three male patients with the performance of acute cerebral infarction onset accepted the rt-PA injection thrombolytic therapy in the intravenous thrombolysis time, while the neurological deifcit symptoms worsen without the risk factors for cerebrovascular disease. Imaging examinations showed lesions coexistence of old and new, large and small, multiple asymmetric cerebral lesions and cerebral atrophy. Serum and cerebrospinal lfuid (CSF) treponema pallidum particle agglutination (TPPA) and toluidine red unheated serum test (TRUST) were positive in 3 cases. The patients received high-dose, full course of penicillin G treatment timely, the prognosis was well, NIHSS and mRS scores were significantly reduced.Conclusion Meningovascular neurosyphilis patients with acute cerebral infarction onset could not be identiifed in a short time. Intravenous thrombolytic treatment was poor, and there is no clear cause of cerebral infarction.To reduce the mistreatment rate of thrombolytic therapy,early syphilis serology and CSF examination was necessary. Large doses of penicillin treatment was effective.