神经梅毒的临床特征及诊治分析

目的探讨神经梅毒的临床、神经影像学和实验室检查特征及其治疗和预后,以提高对该病的诊治水平。方法对本院收治的符合神经梅毒诊断标准的18例神经梅毒患者的临床资料、实验室检查、MRI结果及诊治过程进行回顾性分析。结果临床以间质型梅毒,尤其以脑膜血管梅毒常见,临床表现缺乏特异性;血清梅毒螺旋体凝集试验特异性较高,而脑脊液的阳性率低于血清;头部MRI以梅毒树胶肿表现典型;治疗上除梅毒树胶肿需手术切除外,余类型首选青霉素治疗,有效率93％（14115例）。结论神经梅毒的临床表现及神经影像学无特异性,易误诊,血清或（和）脑脊液梅毒抗体阳性即可确诊,青霉素仍为有效的首选治疗药物。     

神经梅毒9例临床分析

目的探讨神经梅毒临床表现、实验室检查、影像学特征、诊断、治疗及预后。方法回顾分析9例神经梅毒临床资料。结果本组病例共9例,男5例,女4例,年龄38～76岁。脑膜型3例,脑膜血管型1例,麻痹性痴呆4例,脊髓痨1例。颅脑MRI检查4例有脑萎缩,1例脑膜增强,2例有脑梗死。治疗后3例痊愈,5例好转,1例无效。治疗后血清和脑脊液梅毒螺旋体凝胶试验（TPPA）转阴率低于反应素实验（RPR）。结论神经梅毒表现多样,误诊率高,临床表现与分型密切相关,实验室及影像检查是诊断重要依据。     

梅毒血清学试验阳性患者1O例临床分析

目的探讨合并神经系统病变梅毒患者的临床表现、诊断和治疗方法。方法分析10例梅毒血清学试验阳性的梅毒患者的临床特点、血清学及脑脊液检查、影像学表现、诊断、分型及治疗结果等。结果10例患者中据脑脊液结果确诊神经梅毒8例、疑诊1例、非神经梅毒1例。8例神经梅毒确诊病例中脊髓痨型3例、梅毒性脑膜炎2例、麻痹性痴呆1例,树胶肿性神经梅毒1例,脑血管梅毒1例。头颅及脊髓MRI检查异常无明显特异性。青霉素治疗10例,有效9例,失访1例。治疗后脑脊液蛋白、白细胞、压力、脑脊液非螺旋体抗原滴度有不同程度下降。10例患者均未发生赫氏反应。结论神经梅毒临床表现多样,脑脊液检查是诊断的关键。     

神经梅毒12例临床分析

目的探讨神经梅毒的临床特点、诊断和治疗。方法对12例神经梅毒患者的临床资料进行回顾性分析。结果12例神经梅毒患者中麻痹性痴呆6例,脑血管型梅毒3例。脑膜型梅毒2例,脊髓痨1例;血清快速血浆反应素试验（RPR）、梅毒螺旋体抗原凝集试验（TPPA）阳性率为100％,脑脊液-TPPA（CSF-TPPA）阳性率为100％．CSF-RPR阳性率为75％;脑电图和颅脑CT或MRI异常缺乏特异性;大剂量青霉素G治疗安全有效。结论神经梅毒临床表现复杂多样,诊断主要根据临床特点,CSF和血清RPR、TPPA对诊断有重要价值,青霉素G是首选的治疗药物。     

六例先天性神经梅毒患儿的临床特征及治疗分析

目的分析6例先天性神经梅毒患儿的临床特征及治疗,为提高临床对先天性神经梅毒的认识提供参考。方法选取2007年3月—2016年5月南京中医药大学附属南京医院感染科收治的先天性神经梅毒患儿6例,均行腰椎穿刺并发现脑脊液异常,回顾性分析其临床表现、实验室检查、影像学表现、治疗及临床转归。结果 (1)临床表现:4例患儿出现皮疹,多为圆形皮疹,伴或不伴脱皮;无一例患儿出现发热、抽搐、黄疸、肺炎、败血症、颅内出血、消化道出血。(2)实验室检查:6例患儿脑脊液梅毒螺旋体明胶凝集试验(TPPA)均为阳性,脑脊液白细胞计数异常1例,脑脊液蛋白含量(+)2例,脑脊液快速血浆反应素环状卡片试验(RPR)阳性2例;轻中度肝功能异常5例,胆红素指标临界异常3例,贫血3例。(3)影像学表现:3例经骨X线检查发现四肢长骨异常,1例经颅脑CT检查发现脑白质密度减低。(4)治疗及临床转归:4例患儿给予水剂青霉素G治疗,后症状改善,预后良好;1例患儿给予红霉素治疗,结果血RPR滴度不降反升;1例患儿给予头孢曲松治疗,症状改善。结论先天性神经梅毒在临床上较少见,多于出生后6个月内发病,常无神经系统症状,脑脊液TPPA阳性对先天性神经梅毒的诊断价值较高,其治疗首选水剂青霉素G或头孢曲松,不建议使用红霉素。     

神经梅毒38例临床分析及文献复习

［摘要］　目的　探讨神经梅毒患者的临床特征、实验室检查、早期诊断、分型依据和治疗情况。方法　选择2004-09～2014-01江苏大学附属医院、镇江市第一人民医院和江苏大学附属第四人民医院收治的38例神经梅毒患者资料进行回顾性分析。结果　38例患者中男28例，女10例，年龄1 d～75岁，平均51.1岁，神经梅毒患者中间质型10例(脑膜血管梅毒8例，脊髓膜血管梅毒1例，脑膜神经梅毒1例)，主质型22例(麻痹性痴呆14例，脊髓痨8例)，视神经损害2例，无症状型神经梅毒3例，先天性神经梅毒1例；血清、脑脊液快速血浆反应素试验（RPR）及梅毒螺旋体特异抗体测定（TPPA）均阳性，部分患者脑脊液检查显示脑脊液蛋白质含量升高和白细胞计数升高(以单核细胞为主)。除3例放弃治疗外，35例经治疗后好转的患者血清及脑脊液抗体滴度均有不同程度降低，脑脊液白细胞数、蛋白量均降至正常。结论　神经梅毒可防可治，脑脊液梅毒诊断试验是神经梅毒诊断的重要依据，同时需结合临床表现及其他检查进行综合分析，及时正确治疗能够控制病情。     

神经梅毒五例临床分析

目的分析神经梅毒的临床及辅助检查特点,为早期诊断提供依据。方法对5例神经梅毒的患者的资料进行回顾性分析。结果神经梅毒以精神症状,认知障碍为主要表现。影像学上可表现为局灶性缺血灶、脑白质信号异常、脑室扩张等,血管造影可见血管多处狭窄。实验室有特征性快速血浆反应素试验(RPR)、梅毒螺旋体被动颗粒凝集试验(TPPA)阳性。结论神经梅毒早期临床并无特异性表现,应注意筛查,临床医生应提高警惕,大剂量青霉素多能取得显著疗效。     

20例HIV抗体阴性神经梅毒患者的临床分析

目的总结神经梅毒的临床特征以提高对其疾病的认识。方法回顾性分析了20例艾滋病病毒(HIV)抗体阴性的神经梅毒患者的临床表现、实验室检查和影像学特点。结果20例神经梅毒患者中,无症状神经梅毒2例,间质型神经梅毒9例,实质型神经梅毒8例(麻痹性痴呆5例和脊髓痨3例),特殊类型神经梅毒(多颅神经损害)1例。实验室检查示,63.16%的患者脑脊液快速血浆反应素试验(CSF-RPR)阳性,100%的梅毒螺旋体抗原凝集试验(CSF-TPPA)阳性,脑脊液蛋白和细胞数增高分别为75%和50%;头颅CT和MRI表现脑萎缩、梗死或脱髓鞘病变。结论神经梅毒的临床表现与其分型密切相关,实质型神经梅毒应引起重视;TPPA或许在神经梅毒脑脊液检测中可以使用,但神经梅毒的诊断应结合临床表现及辅助实验检查综合分析。     

神经梅毒10例临床分析

目的分析神经梅毒的临床特征,探讨其诊断、治疗及预后。方法回顾性分析了我院2013年7月~2017年1月收治的10例神经梅毒病例。结果 10例患者中,其中2例女性,8例男性。10例患者在确诊神经梅毒前存在误诊。所有患者的脑脊液白细胞数、蛋白均有所升高,血清及脑脊液TPPA及RPR均为阳性。除1例患者失访外,其他9例患者临床症状均有明显改善。结论神经梅毒发病形式多变,易出现误诊情况,其诊断需结合临床表现、血清TPPA和RPR、脑脊液TPPA和RPR、脑脊液白细胞数和蛋白及影像学检查,早期诊断、早期治疗可改善预后。     

脑脊液免疫球蛋白作为神经梅毒诊断和愈后判断指标的研究

目的探讨脑脊液免疫球蛋白对神经梅毒的诊断和愈合判断的价值。方法回顾36例多次住院神经梅毒临床和实验室检查等资料,采用SPSS 17.0进行统计分析。结果36例神经梅毒患者中无症状神经梅毒13例,麻痹性痴呆11例,脑膜血管梅毒5例,脊髓痨5例,脑膜神经梅毒2例。初次检查脑脊液免疫球蛋白(Ig)IgG、白细胞、IgM、IgA和蛋白升高分别为35例(97.2%)、30例(83.3%)、29例(80.6%)、26例(72.2%)、25例(69.4%)。血清甲苯胺红不加热试验(TRUST),脑脊液TRUST、IgA、IgG、IgM、白细胞、蛋白皆较治疗前降低,差异有统计学意义(P<0.05)。结论脑脊液中的免疫球蛋白可以作为神经梅毒的诊断和愈后判断的新指标。     

梅毒流行病学和诊疗现状分析

梅毒是由梅毒螺旋体感染引起的一种慢性传染病,主要传播方式为性接触、血液传播和垂直传播,危害性极大。近年来,梅毒疫情呈上升趋势,已成为我国发病率最高的性传播疾病。梅毒的发病率存在地区差异性,发病人群有从高危人群向普通人群扩大的趋势,尤其是农民工、老年患者发病率较高。目前,梅毒的实验室诊断主要有病原学诊断、血清学诊断、组织病理诊断、基因诊断和脑脊液检查。血清学检查因其简便、可靠,目前临床上应用最为广泛。梅毒的治疗应遵循早期、规范、足量的原则。青霉素是治疗梅毒的首选药。     

Brucellar meningitis

Neurobrucellosis develops in less than 5% of cases of systemic brucellosis; however, most patients with neurobrucellosis have meningeal involvement. Seven new cases of brucellar meningitis and 17 cases from the Spanish- and English-language medical literature are analyzed in terms of epidemiologic data, clinical manifestations, laboratory results for cerebrospinal fluid and serum, treatment, and course of the disease. Brucellar meningitis mimics other neurologic and non-neurologic conditions, and its diagnosis is only suggested in the presence of adequate epidemiologic information. Isolation of Brucella from the cerebrospinal fluid is uncommon. Treatment is accomplished with the combination of tetracycline or doxycycline and streptomycin, rifampin, or both. Mean length of therapy in the seven new cases was 8.5 months. Brucellar meningitis has a better prognosis than other forms of chronic meningitis, and mortality is low for reasons that are not clear; however, the incidence of minor sequelae is high.     

噬血细胞综合征12例临床分析

目的探讨噬血细胞综合征的临床表现、诊断及治疗方法。方法对12例患者进行回顾性分析。结果12例患者中感染相关性8例，肿瘤相关性3例，原因不明1例。治愈6例，好转1例，死亡5例。结论根据临床症状，体征和实验室检查，骨髓细胞学检查，多可获得诊断，对于治疗应主要针对病因，应用肾上腺糖皮质激素，由恶性疾病引起及病因未明者预后较差。     

Clinical analysis of aseptic meningitis caused by echovirus 13

We examined the clinical symptoms and laboratory findings of 21 children with aseptic meningitis caused by echovirus 13 during the summer of 2002. All patients (mean age: 8.3 years) complained of fever and headache. Some had mild vomiting and some had severe vomiting of 4 times or more. In the early stage of the disease, the mean count of WBC was 8,283/microliter, mean level of CRP was 0.8 mg/dl, and there were no abnormalities in levels of GOT, GPT, or LDH. The levels of protein and sugar, in cerebrospinal fluid showed no abnormalities, and mean total cell count was 560/microliter. The mean number of polynuclear cells was 357/microliter, and of mononuclear cells was 203/microliter, showing polynuclear cell predominance. In the recovery period, the tendency to polynuclear cell predominance in the early stage of the disease shifted to mononuclear predominance. One of the 21 patients exhibited multinucleated cell predominance in the cerebrospinal fluid, a high CRP value of 6.2 mg/dl, as well as symptoms of restlessness including numbness of the limbs, hyperpnea, and excitation, needed careful diagnosis as aseptic meningitis. Almost all of the patients were mild cases, and no large differences were seen with the clinical and laboratory findings in previous reports of echovirus aseptic meningitis.     

结核性脑膜炎脑脊液中糖浓度与临床表现关系的研究

目的探讨脑脊液(CSF)中糖浓度<1.0mmol/L结核性脑膜炎患者的临床特点,治疗和预后。方法回顾分析2001年11月至2006年5月在华中科技大学附属同济医院临床确诊为结核性脑膜炎114例患者的临床资料,按CSF中糖浓度是否低于1.0mmol/L分成两组,并对两组患者的临床症状、体征、CSF各项指标,影像学结果以及预后情况进行分析比较。结果CSF中糖浓度低于1.0mmol/L的结核性脑膜炎患者可能主诉症状持续时间(P=0.007),病情程度,共济失调(P<0.01),意识模糊(P<0.01),人格改变(P=0.014),失禁(P=0.030),小脑性共济失调(P<0.01),Glasgow昏迷等级(P=0.023),新发脑梗死(P<0.01)和1年后的预后不良(P<0.01)较对照组严重。结论结核性脑膜炎CSF中糖浓度低于1.0mmol/L的患者入院病情较重,可能遗留更多的持续性神经功能缺损。     

Clinical and magnetic resonance imaging manifestations of neurosarcoidosis

OBJECTIVES: To describe clinical and neuroimaging manifestations of neurosarcoidosis in a cohort of 21 patients. PATIENTS AND METHODS: We reviewed records of 21 patients with sarcoidosis and central nervous system (CNS) manifestations referred to Cooper University Hospital, with emphasis on neuroimaging findings and associated clinical and laboratory evidence of sarcoidosis. Nineteen patients were categorized as having "definite," "probable," or "possible" neurosarcoidosis, while 1 had associated CNS vasculitis and another had Hodgkins lymphoma with cauda equina syndrome. RESULTS: The most common manifestations included myelopathy, cranial neuropathies, and encephalopathy. In 6 patients, CNS biopsy showed sterile, noncaseating granuloma (NCG), while in the remainder, the diagnosis was established through a combination of clinical, radiographic, and laboratory findings. Notably, 10 patients developed acute neurological emergencies, including seizures, spinal cord compression, and increased intracranial pressure. Findings on magnetic resonance imaging (MRI) included a variety of manifestations, including isolated mass lesion, diffuse intraparenchymal inflammatory lesions in the brain and spinal cord, leptomeningeal enhancement, hydrocephalus, and intracranial hemorrhage. CONCLUSIONS: Sarcoidosis is associated with diverse neurological manifestations and neuroimaging findings. The diagnosis of isolated CNS sarcoidosis requires a biopsy to document the presence of sterile NCG and to exclude neoplasms and other granulomatous diseases. When a biopsy of the CNS is not possible, a diagnosis of neurosarcoidosis can reasonably be supported in many patients by MRI findings and exclusion of other disorders. RELEVANCE: Optimum management of patients with neurosarcoidosis relies on the ability of clinicians to recognize the broad spectrum of clinical and neuroimaging manifestations of the disorder.     

Treatment of latent syphilis in HIV-infected patients with 10 d of benzylpenicillin G benethamine: a prospective study in Maputo,Mozambique

Neurosyphilis has been reported in HIV-infected patients previously treated with penicillin G benzathine, which does not achieve treponemicidal levels in cerebrospinal fluid. Therapy combining benzylpenicillin G and its repository form benzylpenicillin G benethamine could be a potentially effective alternative enhanced regimen for treating latent syphilis in HIV-infected patients because peak serum and cerebrospinal fluid concentrations would be achieved early post-administration by the former molecule and sustained for 24 h due to the prolonged half-life of the latter. In this study, 23 asymptomatic HIV and Treponema pallidum co-infected patients received 10 d of combined therapy (2 M IU intramuscular once daily) and were followed up at 3, 6 and 12 months. None experienced side effects or clinical symptoms. Of the 18 patients who were evaluated 1 y later, 8 (44.4%) exhibited serological treatment failure, defined as a positive serum rapid plasma reagin test. In conclusion, a 10-d regimen combining penicillin G and penicillin G benethamine seems to be of no benefit compared to currently recommended treatment.