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。     

脊髓痨临床和影像学特征分析

目的总结脊髓痨的临床和影像学特征。方法回顾分析海军总医院明确诊断的3例及文献报道的7例脊髓痨患者的临床症状与体征、实验室检查、影像学表现、电生理学表现、治疗及预后。结果 10例患者分别以行走不稳、腰腹部和双下肢针刺样或闪电样疼痛、四肢麻木(以双下肢显著)首发,临床主要表现为行走不稳、双下肢麻木、躯干和四肢针刺样或闪电样疼痛、排尿障碍等,以及双下肢腱反射减弱或消失、Romberg征阳性、深感觉障碍、跟-膝-胫试验欠稳准、浅感觉障碍等。血清梅毒螺旋体明胶凝集试验(TPPA)阳性,快速血浆反应素试验(RPR)滴度1∶8~256;脑脊液白细胞计数增加、蛋白定量升高,脑脊液TPPA试验阳性、RPR试验滴度1∶1~8。影像学改变无特异性,多表现为退行性变。体感诱发电位呈现双侧P100波潜伏期延长、波幅降低;神经传导速度无明显变化。其中6例患者经青霉素治疗后症状均缓解。结论脊髓痨临床表现复杂、影像学改变无特异性,易误诊,明确诊断应综合临床症状与体征、实验室检查、影像学和电生理学表现,仅少数患者表现出相应的影像学改变,对诊断有一定提示意义。     

神经电生理检查在脊髓亚急性联合变性中的诊断应用

目的探讨神经电生理检查在脊髓亚急性联合变性(SCD)中的诊断意义。方法回顾性分析42例临床确诊为脊髓亚急性联合变性患者的病例资料,统计磁共振(MRI)检查、神经电生理检查(包括体感诱发电位、运动诱发电位、视觉诱发电位、脑干听觉诱发电位、神经传导及针肌电图)、血清维生素B12水平、症状及体征等,将神经电生理异常率与MRI异常率进行比较。结果神经电生理异常35例,异常率83.3%,其中体感诱发电位、运动诱发电位、视觉诱发电位、脑干听觉诱发电位、神经传导及针肌电图诸项目均可出现异常;MRI异常23例,异常率54.8%。通过SPSS软件处理,符合Pearsonχ2检验,差异有统计学意义(P<0.05)。结论神经电生理检查可客观反映SCD病变部位,异常率高于MRI检查,并可进行定性诊断,在SCD疾病的早期诊断中具有重要价值。     

神经梅毒的临床特征(附12例报道)

目的通过分析神经梅毒的临床特征,探讨其诊断的相关问题。方法回顾性分析经临床和实验室检查确诊的12例神经梅毒住院患者的相关临床资料。结果12例患者中男7例,女5例,平均年龄37.25岁。均承认自己或配偶有非婚姻性生活史。脑脊液检查示全部患者脑脊液梅毒螺旋体血球凝集试验(CSF-TPHA)阳性,脑脊液快速血浆反应素试验(CSF-RPR)阳性者8例,白细胞和蛋白均升高者6例,白细胞单独升高3例,蛋白单独升高1例。头颅MRI表现为脑梗死、脑萎缩、占位性病灶、炎症样病变。12例患者中无症状神经梅毒1例,梅毒性脑膜炎2例,脑膜血管梅毒6例,麻痹性痴呆1例,脊髓痨2例。结论神经梅毒的诊断应综合考虑病史、临床表现、梅毒血清学、脑脊液、影像学等资料。     

神经梅毒的临床特点和诊断

目的分析神经梅毒的临床特点和诊断。方法回顾性分析10例神经梅毒患者的临床资料、实验室和神经影像学检查结果。结果男8例,女2例,平均(45±14.52)岁。无症状神经梅毒1例,脑血管梅毒4例,麻痹性痴呆4例,脊髓痨1例。血清和脑脊液甲苯胺红不加热血清反应素试验(TRUST)和梅毒螺旋体明胶凝集试验(TPPA)均阳性。4例脑脊液白细胞升高(20~80×106/L),分类以淋巴细胞为主,7例脑脊液蛋白升高(0.81~1.56g/L)。3例脑血管梅毒MRI示多发性梗死,3例麻痹性痴呆MRI有脑萎缩表现。结论神经梅毒的临床表现多样,诊断应综合考虑临床表现、梅毒血清学、脑脊液检查、神经影像学和流行病学资料。     

多发性硬化临床特征分析及治疗

目的 探讨多发性硬化(multiple sclerosis,MS) 的临床特征及治疗方法.方法 回顾分析42例MS患者的临床资料.结果 MS 好发于青年女性(29例),常见症状为肢体无力(29例)、视力障碍(22例)和感觉障碍(21例).病变累及大脑半球30例,视神经28例,脊髓23例,脑干9例,小脑4例,所有病例MRI检查均有阳性改变,CSF检查IgG鞘内合成率阳性16例,寡克隆区带阳性19例,抗髓鞘碱性蛋白(MBP)抗体阳性15例.视觉诱发电位(VEP)异常28例,脑干听觉诱发电位(BAEP)阳性16例,体感诱发电位(SEP)异常20例,急性期甲强龙冲击治疗患者临床症状均有改善,缓慢激素减量及小剂量激素长期维持治疗,随访至2008-01仅有7例复发.结论 结合临床特点、MRI、脑脊液免疫学、诱发电位检查能明显提高临床确诊率.急性期甲强龙冲击治疗可改善临床症状,缩短急性期病程,缓慢激素减量及小剂量激素长期维持可能有助于降低复发率.     

神经梅毒7例临床分析

目的分析神经梅毒的临床特征,探讨其诊断及治疗。方法回顾性分析7例神经梅毒患者的临床和实验室资料。结果7例神经梅毒患者中梅毒性脑膜炎2例、脑血管梅毒1例、麻痹性痴呆3例、脊髓痨1例;血清和脑脊液快速血浆反应素(rapid plasma regain,PRP)试验及梅毒螺旋体血凝试验(treponema palliadum hemagglutination assay,TPHA)均阳性。结论神经梅毒根据不同类型有多种发病形式,首诊易误诊,血清和脑脊液梅毒抗体阳性即可确诊,青霉素为首选治疗药物。     

15例晚期神经梅毒的临床表现和实验室检查分析

目的:分析晚期神经梅毒的临床特点及实验室检查。方法: 回顾15例晚期神经梅毒患者的临床特点、血清及脑脊液检查和神经影像学改变。结果:患者年龄33～62岁，平均47.7岁；分为麻痹性痴呆8例，脊髓痨3例，视神经萎缩1例，混合型3例。误诊率高达86.7％，多误诊为病毒性脑炎、精神病、糖尿病性脊髓痨、亚急性联合变性等。起病隐袭，缓慢进展，病程相对较长，具有阿-罗氏瞳孔，可能是麻痹性痴呆与病毒性脑炎的鉴别点；双下肢或下腹部的针刺样或剧烈的闪电样疼痛，并伴有尿便失禁，可能是脊髓痨的重要特点。CSF白细胞数增加、蛋白和IgG水平均明显高于正常。麻痹性痴呆的MRI多表现为额颞叶，特别是颞叶内侧、岛叶的异常，在T2加权和FLAIR相七为高信号，并可见脑皮质萎缩，脑室不同程度扩大，海马萎缩；脊髓痨患者，脊髓MRI可以无明显改变。结论:晚期神经梅毒患者具有一些较特征性的临床表现，而脑脊液白细胞计数、蛋白和IgG水平测定、神经影像学检查对诊断具有重要价值。     

MRI正常的脊髓亚急性联合变性的临床特征分析

目的探讨MRI正常的脊髓亚急性联合变性(SCD)的临床特征、实验室检查、神经电生理特点,提高临床医师对SCD的确诊率。方法回顾性分析民航总医院2015-12—2016-10收治的5例MRI正常的临床确诊为脊髓亚急性联合变性患者的临床资料、血清维生素B12、血红蛋白、血同型半胱氨酸水平、内因子抗体、抗胃壁细胞抗体、血尿铜情况和神经电生理结果。结果5例MRI正常的患者,平均发病年龄67.2岁,男性多于女性,发病至确诊时间均较长,且肌电图及体感诱发电位异常率为100%;维生素B12的营养吸收障碍诱因、临床体征、血清维生素B12、血红蛋白、血同型半胱氨酸水平在此类患者中无明显特异性;内因子抗体、抗胃壁细胞抗体、血、尿铜对诊断有指导意义。5例患者经治疗症状均有改善,但改善不显著。结论 5例MRI正常的患者,发病平均年龄67.2岁,男性多于女性,发病至确诊时间均较长,且肌电图及体感诱发电位异常率为100%;维生素B12的营养吸收障碍诱因、临床体征、血清维生素B12、血红蛋白、血同型半胱氨酸水平在此类患者中无明显特异性;内因子抗体、抗胃壁细胞抗体、血、尿铜对诊断有指导意义。5例患者经治疗症状均有改善,但改善不显著。     

神经梅毒的临床表现（附7例报道）

目的:探讨神经梅毒患者的临床表现、诊断和治疗。方法:回顾性分析7例神经梅毒患者的临床症状、体征,磁共振特点,血清、脑脊液变化及治疗。结果:7例患者中,脑膜血管型梅毒4例,脊髓痨1例,麻痹性痴呆1例,脑膜梅毒1例。头颅MRI异常6例,脊髓MRI异常1例,但无明显特异性。治疗后脑脊液蛋白、细胞数下降,血清及脑脊液TPPA无明显下降,血清及脑脊液RPR有不同程度下降。经青霉素或头孢曲松治疗,6例有效,1例出院2个月后复发。7例均未发生吉-海反应。结论:神经梅毒临床表现多种多样,临床极易误诊,脑脊液检查是关键。     

脊髓痨临床与神经电生理特征初步研究(附3例误诊病例报告)

目的探讨目前脊髓痨的临床与神经电生理特征。方法结合文献报道病例,回顾性分析近3年在我院及院外误诊的3例脊髓痨患者的临床与实验室资料。结果目前脊髓痨的主要临床特征为:除行走不稳、下肢深感觉障碍、跟膝反射减弱或消失以及Romberg征阳性外,其他典型临床特征缺乏。末梢型感觉异常成为主要临床表现。电生理检查神经传导速度正常。结论目前对于定位于脊髓(尤其是腰髓)后根、后索以及周围神经病变的患者,尤其是年龄40～60岁、电生理检查神经传导速度正常者,需要注意鉴别脊髓痨。     

18例HIV阴性的神经梅毒诊断

目的 分析HIV阴性的神经梅毒的临床特点及诊断.方法 回顾18例HIM阴性的神经梅毒患者的临床分型、临床特点、血清及脑脊液检查和影像学改变.结果 患者年龄33～62岁,平均(46.0±9.2)岁;分为脑膜血管型3例,麻痹性痴呆8例,脊髓痨3例,视神经萎缩1例,混合型3例.最常见的症状是认知减退、阿一罗氏瞳孔、步态不稳和共济失调、双下肢腱反射消失、精神行为异常等.误诊率高达72.2％,其中误诊为病毒性脑炎4例.血清梅毒螺旋体特异性抗体检测均为阳性,血清和CSF梅毒螺旋体明胶凝集试验(TPPA)阳性率高,CSF白细胞数增加、蛋白升高;影像学表现缺乏特异性.结论 无法根据单一的实验室检查或临床表现确诊神经梅毒.血清梅毒螺旋体特异性抗体是重要的初筛实验,血清、脑脊液RPR和TPPA可作为确证实验,将临床表现与脑脊液白细胞计数、蛋白含量、神经影像学特点结合起来,综合分析,才能避免误诊和漏诊.     

Somatosensory evoked potential in neurosyphilis

Since the development of effective antibiotic therapy, the occurrence of neurosyphilis has become less frequent. The number of syphilitic patients is gradually increasing as a complication in acquired immunodeficiency syndrome, but the diagnosis of neurosyphilis sometimes is difficult. We describe six patients with neurosyphilis and an analysis of their tibial nerve somatosensory evoked potentials. Four of them, including two with no tabes dorsalis symptoms, had delayed P15-N21 or the absence of N21. These abnormalities were ameliorated by treatment for syphilis. Analysis of tibial nerve SEPs provides a useful tool for the diagnosis of neurosyphilis and the evaluation of the extent to which neurosyphilis has progressed. Received: 20 December 2001, Received in revised form: 15 March 2002, Accepted: 18 March 2002     

Tabes dorsalis: electrodiagnostic features.

Electrodiagnostic data have not been previously reported in tabes dorsalis. A patient with tabes dorsalis is described whose nerve conduction studies and median nerve somatosensory evoked responses (SEPs) were normal. H-reflexes were absent. SEPs of the tibial nerve suggested posterior column dysfunction. These electrodiagnostic findings correlate precisely with the known pathology of tabes dorsalis.     

神经梅毒26例磁共振成像表现

目的 分析不同临床类型神经梅毒的MRI表现.方法 回顾性研究26例神经梅毒患者的临床及MRI资料,描述各种临床类型神经梅毒的MRI表现.结果 26例神经梅毒患者中,17例MRI有异常表现.其中脑膜血管型梅毒7例,主要表现为脑部多发的缺血灶、梗死灶,少数表现为脑炎样改变;麻痹性痴呆6例,主要表现为额、颞叶萎缩,少数伴有脑缺血灶、颗粒性室管膜炎及海马硬化;脊髓膜血管梅毒3例,主要表现为下颈段至下胸段脊髓轻度肿胀,其内可见多发的缺血灶;脊髓痨1例,其脑部MRI表现为缺血灶.9例患者MRI表现正常,其中脑膜型梅毒4例,脊髓痨5例.结论 不同临床类型神经梅毒的MRI表现具有一定特征,但缺乏特异性,临床上容易误诊.     

Somatosensory evoked potentials in a case of neurosyphilis

Here we report median and common peroneal nerve SEPs in a patient with tabes dorsalis. SEPs were within normal limits following median nerve stimulation, but of prolonged latency for common peroneal nerve. This was in keeping with clinical findings of posterior column involvement confined to the lumbosacral tract and with pathological features of tabetic neurosyphilis.

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Sommario Gli autori riportano le caratteristiche dei potenziali evocati somatosensoriali del nervo mediano e peroneo comune in un paziente affetto da tabe dorsale. I potenziali evocati somatosensoriali sono risultati nei limiti della norma stimolando il nervo mediano ma di latenza aumentata per il nervo peroneo comune. Ciò risultava in accordo sia con le caratteristiche cliniche di segni di interessamento dei cordoni posteriori limitato al tratto lombosacrale che con le caratteristiche anatomopatologiche della neurosifilide.

     

Spectrum and characterization of movement disorders secondary to neurosyphilis

There have been frequent reports of Neurosyphilis with atypical features. Syphilitic infection of the central nervous system can result in various movement disorders (MD). The few reports of MD patients with neurosyphilis have been mainly of single patient. Between June 2005 and February 2012 we identified, 169 in-patients with neurosyphilis at Zhongshan Hospital. We performed a retrospective chart review to characterize MD findings, clinical signs and symptoms, misdiagnosis rate, laboratory findings, and brain magnetic resonance imaging results. We found that seven of the 169 neurosyphilis patients presenting with MD, had originally been misdiagnosed with Parkinsonism (4), laryngeal dystonia (1), corticobasal syndrome (1), and sensory ataxia (1). None of these patients were initially suspected of having neurosyphilis. The correct diagnosis was syphilitic meningitis (1), meningovascular neurosyphilis (2), general paresis (3), and tabes dorsalis (1). Among them, six patients had abnormal imaging studies, and sera rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) from all seven patients were positive. The cerebrospinal fluid (CSF) examinations showed that four patients were CSF-RPR positive (titers ≤1:16) by CSF syphilitic serologic testing, but all seven patients were CSF-TPPA reactive. Moreover, two patients had CSF pleocytosis and four patients had elevated CSF protein expression. Our findings reinforced the importance of routine serologic testing for syphilis should be a part of the evaluation of patients with atypical MD presentations or in whom alternative diagnoses are not forthcoming. When serology is positive, all patients should be examined more thoroughly for neurosyphilis by lumbar puncture.     

Neurosyphilis in the antibiotic era

Among 30 patients with neurosyphilis diagnosed between 1970 and 1981, 43% had symptoms attributable to neurosyphilis, 43% had unrelated symptoms, and 14% were asymptomatic. Serum VDRL was positive in 86%, and the CSF VDRL was positive in 53%. Meningovascular and vascular syphilis were relatively more common than in the prepenicillin era; tabes dorsalis and general paresis were unchanged in relative frequency.