神经梅毒的临床特点

目的 探讨神经梅毒的临床特点.方法 对22例神经梅毒患者的临床资料进行回顾性分析.结果 本组男17例,女5例.首发症状为为智能下降10例,精神症状4例,卒中样发作3例,癫痫发作2例,头痛2例,双下肢无力1例.主要临床症状包括卒中样发作4例,智能下降12例,精神症状10例,癫痫发作7例,睡眠障碍6例,头痛4例,双下肢无力1例.22例患者查血清快速血浆反应素试验(RPR)、梅毒螺旋体特异抗体检测(TPHA)均阳性;17例行脑脊液RPR、TPHA试验,15例RPR阳性,16例TPHA阳性;18例患者脑脊液白细胞及蛋白含量升高.17例患者行脑电图检查,有8例异常,均表现为广泛性慢波.20例行MRI检查,异常19例,主要累及皮质和皮质下白质,呈长T.、长T2异常信号改变.经大剂量青霉素治疗后,20例患者症状明显缓解,2例复发.结论 神经梅毒多见于中年男性,主要症状为智能下降及精神症状;血浆及脑脊液TPHA、RPR阳性,脑脊液细胞数及蛋白升高.     

以癫痫发作为首发症状的神经梅毒患者临床特点分析

目的总结以癫痫发作为首发症状的神经梅毒患者的临床特点。方法回顾性分析2014年1月至2018年1月作者医院收治的8例以癫痫发作为首发症状的神经梅毒患者的临床特征及实验室检查特点,并进行文献复习。结果 8例患者均为男性,年龄36～66岁。2例患者为脑膜血管型神经梅毒,2例为脑膜型神经梅毒,4例为麻痹性痴呆。7例患者癫痫发作形式为全面性发作,1例为局灶性发作继发全面性发作。4例(4/8)患者初诊时被误诊。8例患者血及脑脊液甲苯胺红不加热血清试验(TRUST)均为阳性。7例患者脑脊液白细胞计数增高,6例患者脑脊液蛋白增高,5例患者脑脊液白细胞计数和蛋白均增高。7例患者脑MRI检查可见异常改变,包括脑萎缩、脑梗死灶及脱髓鞘改变等,1例可见左侧颞叶高信号;另1例患者脑MRI检查结果正常。脑电图检查结果显示3例患者正常,4例异常,主要表现为慢波增多和癫痫波发放。经过青霉素治疗,8例患者癫痫发作均得到有效控制。结论以癫痫发作为首发症状的疾病病因鉴别诊断需考虑梅毒感染的可能,早期诊断和及时进行青霉素治疗对预后非常重要。     

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。     

神经梅毒12例临床特征及影像学分析

目的探讨神经梅毒的临床特征及影像学表现。方法回顾性分析2000年1月~2008年4月我院收治的12例神经梅毒患者的临床资料。结果12例神经梅毒患者中脑卒中样起病6例,麻痹性痴呆2例,脊髓损害2例,脑膜炎及神经炎各1例;血清梅毒甲苯胺红不加热血清反应素试验及梅毒螺旋体明胶颗粒凝集试验均呈阳性反应;部分患者脑脊液检查示蛋白质含量升高、白细胞计数升高(以单个核细胞为主)。MR检查分别表现为脑梗死灶、脑萎缩、脑皮质异常信号、脑动脉狭窄或闭塞及脊髓空洞症等。结论梅毒螺旋体对神经系统的损害比较弥散,神经梅毒的诊断应结合临床表现、实验室及神经影像学检查资料综合分析,早期诊断、早期治疗对本病预后有重要意义。     

梅毒性血管炎的临床特点

目的 探讨梅毒性血管炎的临床特点.方法 回顾性分析4例梅毒性血管炎患者的临床资料.结果(1)4例患者均为男性,年龄38 ～ 68岁,均无明确的脑血管病危险因素.均为急性起病,其中3例表现为偏瘫、失语,1例有精神行为异常;(2)4例患者CSF检查都存在蛋白、细胞轻度升高;血清及CSF快速反应素环状卡片试验(RPR)、螺旋体血球凝结试验(TPHA)均阳性;(3)4例患者头颅影像学检查显示脑缺血性病变,其中3例脑血管呈现多发狭窄改变;(4)青霉素治疗后,临床症状及实验室指标均有明显好转.结论 梅毒性血管炎多呈卒中样起病;血清及CSF梅毒特异性抗体阳性及头颅影像学检查显示脑血管炎改变是确诊依据;青霉素治疗有效.     

以癫(癎)为首发症状的神经梅毒临床分析(附3例报告)

目的 提高对神经梅毒的认识.方法 对3例以癫(癎)为临床首发症状并确诊为神经梅毒的临床资料进行回顾性分析.结果 3例患者均以癫(癎)为临床首发症状,血清、脑脊液的快速血浆反应素试验(RPR试验)和梅毒螺旋体明胶凝集试验(TPPA试验)均阳性,脑脊液的蛋白含量均异常,细胞学检查1例异常,2例患者EEG示(癎)样放电,经大剂量青霉素等治疗后癫(癎)症状消失.结论 对于成年人初次发作的癫(癎)应考虑排除神经梅毒的可能.     

梅毒性视神经炎12例临床分析

目的总结梅毒性视神经炎临床特点和病理生理学机制。方法回顾分析12例梅毒性视神经炎患者的临床症状与体征、实验室检查、电生理学检查、影像学检查、治疗及预后。结果 12例患者(18只眼)均以视力下降为主要表现,呈急性或亚急性起病,呈单眼或双眼先后发病,视力损害程度不尽一致,伴视野缺损、眼底改变;脑脊液白细胞计数增加、蛋白定量升高;血清快速血浆反应素试验(RPR)和梅毒螺旋体血凝试验(TPHA)阳性,脑脊液RPR试验/甲苯胺红不加热血清试验和TPHA试验阳性;视觉诱发电位P100波潜伏期延长、波幅降低;MRI显示视神经萎缩、视神经眶内段或视神经全长异常信号;予水剂青霉素静脉滴注和苄星青霉素肌肉注射后视力好转。结论神经梅毒作为视神经炎的病因临床并不常见,应注意与特发性视神经炎和缺血性视神经病变相鉴别,梅毒血清学和脑脊液检测有助于诊断,早期诊断和规范治疗对视力恢复至关重要。     

以癫为首发症状的神经梅毒临床分析(附3例报告)

目的提高对神经梅毒的认识。方法对3例以癫为临床首发症状并确诊为神经梅毒的临床资料进行回顾性分析。结果3例患者均以癫为临床首发症状,血清、脑脊液的快速血浆反应素试验(RPR试验)和梅毒螺旋体明胶凝集试验(TPPA试验)均阳性,脑脊液的蛋白含量均异常,细胞学检查1例异常,2例患者EEG示样放电,经大剂量青霉素等治疗后癫症状消失。结论对于成年人初次发作的癫应考虑排除神经梅毒的可能。     

24例神经梅毒回顾性分析

目的:通过分析和总结神经梅毒患者的临床特征,旨在减少神经梅毒的临床误诊。方法:回顾性分析2013年1月—2017年1月上海交通大学医学院附属仁济医院神经内科收治的24例神经梅毒患者的临床资料。结果:24例神经梅毒患者中,男性21例,女性3例;中位年龄为55岁(范围:28~75岁);首发临床表现为癫痫者3例,麻痹型痴呆者3例,脑血管病样发作者5例,有脊髓症状者5例。24例患者的血清梅毒螺旋体明胶颗粒凝集试验(treponema pallidum particle assay,TPPA)和非梅毒螺旋体抗原血清试验——甲苯胺红不加热血清试验(tolulized red unheated serum test,TRUST)以及脑脊液TPPA均为阳性。其中,脑脊液细胞计数异常者21例,蛋白含量增加者20例。头颅计算机断层成像(computed tomography,CT)和磁共振成像(magnetic resonance imaging,MRI)显示腔隙脑梗死10例,急性脑梗死3例,脑出血1例,血管狭窄、变细、不显影5例,核团异常信号1例,脊髓感染性肉芽肿1例,脊髓异常信号1例,脑叶异常信号2例,脑萎缩和海马萎缩2例,颅内无异常表现4例。所有患者在确诊神经梅毒后均立即接受青霉素治疗,症状好转。结论:通过结合临床表现、实验室检查及影像学检查,有助于减少神经梅毒的误诊。     

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。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -