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神经梅毒临床误诊病例分析
引用本文:叶励超,林弘,黄玉婷,慕容慎行.神经梅毒临床误诊病例分析[J].中国现代神经疾病杂志,2004,4(6):378-381.
作者姓名:叶励超  林弘  黄玉婷  慕容慎行
作者单位:1. 362000,泉州,福建医科大学附属第二医院神经内科
2. 福建医科大学附属第一医院神经内科
3. 362000,泉州,福建医科大学附属第二医院检验科
摘    要:目的分析神经梅毒误诊原因,提高诊断的准确率。方法回顾性分析2001年1月-2004年2月曾经在院外误诊的12例神经梅毒患者的临床资料及误诊原因。结果12例患者中2例脑膜血管梅毒者被误诊为动脉硬化性脑梗死,2例脑膜梅毒被误诊为结核性脑膜炎和动脉瘤,2例脊髓痨被误诊为多发性神经炎,6例全身麻痹性痴呆被误诊为阿尔茨海默病、血管性痴呆、慢性酒精中毒性脑病、急性病毒性脑炎、路易体痴呆和帕金森病合并痴呆。误诊原因主要为:临床问诊忽略了患者的冶游史以及患者和家属有意隐瞒病史;体格检查不全面和定位诊断错误;全身性神经梅毒的临床表现不典型;神经梅毒的临床表现复杂多样,临床医师对其认识不足,病因诊断时考虑不充分(误诊的最主要原因)。结论神经梅毒临床表现较为复杂,临床医师对此应有充分认识,对可疑病例应注重询问相关病史,认真进行全面体格检查及特异性的血清学、脑脊液检查,以提高对本病诊断的准确率。

关 键 词:神经梅毒  误诊原因  诊断  患者  临床误诊  诊病  体格检查  临床医师  临床表现  病史
修稿时间:2004年8月16日

Analysis of misdiagnosed cases with neurosyphilis
YE Lichao,LIN Hong,HUANG Yuting,et al..Analysis of misdiagnosed cases with neurosyphilis[J].Chinese Journal of Contemporary Neurology and Neurosurgery,2004,4(6):378-381.
Authors:YE Lichao  LIN Hong  HUANG Yuting  
Institution:YE Lichao,LIN Hong,HUANG Yuting,et al. Department of Neurology,Second Affiliated Hospital,Fujian Medical University,Quanzhou 362000,China
Abstract:Objective To analyze the cause of misdiagnosis in neurosyphilis for improving the diagnostic level. Methods The clinical data and causes of 12 patients with neurosyphilis misdiagnosed out hospital during January 2001 to February 2004 were analyzed retrospectively. Results Of these 12 cases, there were two with meningovascular syphilis misdiagnosed as atherosclerotic cerebral infarction, two with meningeal syphilis misdiagnosed as tubercular meningitis or aneurysm respectively, two with tabes spinalis misdiagnosed as polyneuritis, and the other 6 cases with general paralytic aphrenia were misdiagnosed as Alzheimer disease, vascular dementia, chronic encephalopathia alcoholica, acute viral encephalitis, Lewy-body dementia or Parkinson-dementia respectively. The main causes leading to misdiagnosis included: neglect of the patients' whoring history or intentionally concealed the sex related facts by patients' family; incomplete physical examination or mistake in localization diagnosis and atypical manifestation of systemic neurosyphilis. Since the complex and diversified clinical manifestations of neurosyphilis, physician's knowledge lacking sufficient understanding on the etiology, and incomplete consideration in diagnosis might be the leading cause of misdiagnosis. Conclusion Physicians should brequently bear in mind that the manifestations of neurosyphilis are rather complex thus physicians should have sufficient knowledge in this field and pay more attention to history taking especially the sex ralated history in those suspected cases. The thorough physical examination and specific serological and cerebrospinal fluid examination are necessary for improving the definite diagnostic rates of neurosyphilis.
Keywords:Neurosyphilis Diagnosis Diagnostic errors
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