A case of general paresis with marked improvement of cerebral blood flow after antiluetic therapy--case report]

Although the incidence of neurosyphilis has declined dramatically after the World War II because of the development of antibiotics, it is recently increasing a little bit. There has been few reports on the neuroimaging of general paresis. We studied a fresh case of general paresis by X-ray CT (XCT), MRI and PET scans, and report the changes of neuroimages before and after the therapy. A 38-year-old man was admitted with disorientation, thought disorder and personality change. He also had insomnia and megalomania. There were neither obvious neurological signs nor particular changes of the XCT scan abnormalities on admission. His clinical symptoms were gradually worsened within three months, when the XCT and MRI scans showed moderate brain atrophy especially in the frontal and temporal lobes with mild dilatation of the lateral ventricles. In the PET study, the cerebral blood flow was decreased in the entire brain, especially in the frontal lobes, although the thalamus and the basal ganglia had normal levels. By immunological procedures and the cerebrospinal fluid (CSF) studies, the diagnosis of general paresis was made. He was treated with penicillin G and other antibiotics. In one year after his first therapy, many symptoms vanished. Although the cerebral atrophy was a little advanced, the cerebral blood flow was dramatically increased. As far as we know, this is the first PET study of general paresis before and after penicillin treatments.     

阿尔茨海默氏病与血管性痴呆临床特点的对照研究

目的比较阿尔茨海默氏病（AD）与血管性痴呆（VD）的临床特点。方法对39例AD和38例VD患者的精神行为症状特点、伴随的躯体疾病、头颅CT检查以及脑电图检查进行比较。结果AD组与VD组在幻觉、妄想等精神病性症状方面无明显差异,在抑郁、焦虑等情绪障碍以及行为脱抑制方面有显著差异;AD组伴随的躯体疾病无明显特异性,VD组多伴发高血压、冠心病;AD组头颅CT多表现为脑萎缩,VD组多表现为脑梗塞;脑电图检查AD组无明显特异性,VD组界限脑电图居多。结论AD与VD患者的BPSD及所伴随的躯体疾病可有不同特点,CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

Changes in EEG mean frequency associated with anxiety and with amphetamine challenge in BPD

Recent authors have hypothesized that cerebral dysfunction, as reflected in an abnormal EEG, may play an important role in the behavioral symptoms of patients with borderline personality disorder (BPD). Spectral analysis and amphetamine challenge testing are two promising methods for probing the clinical symptomatology of this disorder. In this study, we evaluated the relationship between clinical symptoms and computerized EEG spectral analysis in BPD patients both before and after amphetamine challenge. We found that mean frequency values on spectral analysis consistently correlated with anxiety levels in our patients, but did not correlate with a wide variety of other important symptoms, such as depression or transient psychosis. This result, coupled with our previous negative findings concerning EEG abnormalities in patients with BPD, casts doubt on the etiological relationship of cerebral dysrhythmias to the behavioral pathology of this disorder, but raises interesting questions concerning the relationship of anxiety and mean frequency.     

Clinical presentation and imaging of general paresis due to neurosyphilis in patients negative for human immunodeficiency virus

The clinical presentations and MRI of six patients with general paresis due to neurosyphilis were reviewed. Diagnosis was based on neurological and psychiatric symptoms, positive Treponema pallidum hemagglutination in cerebrospinal fluid (CSF) and sera, and serology that was negative for human immunodeficiency virus by enzyme-linked immunosorbent assay. Most patients had lymphocytic, monocytic pleocytosis and high protein levels in their CSF. One patient had periodic lateral epileptiform discharges, one patient had epileptiform discharges and three patients had slowing of background activity on electroencephalography. Two patients had hyperintense signal abnormalities in the anterior and mesial temporal lobe, while four patients were found by MRI to have cerebral atrophy. Three patients developed white matter lesions. Therefore, clinical, electroencephalography and MRI findings are valuable in the diagnosis of general paresis of neurosyphilis.     

The EEG manifestations of chronic ethanol abuse: relation to cerebral cortical atrophy

Eleven chronic alcoholic patients without other nonneurological or traumatic disease were evaluated by a simultaneous electroencephalogram and computerized axial tomogram. The findings suggested that chronic abusers of approximately 60 years of age or less may have a normal EEG despite the presence of cerebral cortical atrophy or dementia. In alcoholics over 60 years of age, the greater the severity of cerebral cortical atrophy, the greater the slowing in background frequency of the EEG. Voltage diminution and slow-wave transients also occurred more frequently in the older patients. The incidence of EEG abnormalities was greater than the incidence of CAT scan evidence for cerebral cortical atrophy in alcoholics over 60 years of age with dementia.     

以痴呆为突出表现的神经梅毒系统分析

目的 探讨以痴呆为突出表现的神经梅毒的临床特征及其治疗方法和预后,以期提高对该病的诊治水平.方法 计算机检索中国生物医学文献数据库(CBM)和Medline,对1989年至今国内外文献中公开发表的以痴呆为突出表现的梅毒患者的病历资料(病例报告形式)进行回顾性分析.结果 纳入44篇文献共62例患者(6)例麻痹性痴呆及1例梅毒性精神神经病患者),其临床特征包括:(1)男性多见;(2)多数隐匿起病;(3)首发症状以记忆力减退和性格改变多见;(4)MRI、CT以脑萎缩为主;(5)血清、CSF梅毒抗体检查阳性,也可有特殊情况;(6)确诊较困难;(7)驱梅治疗近期症状可不同程度改善;(8)远期预后证据缺乏.结论 (1)麻痹性痴呆和梅毒性精神神经病均可有痴呆表现;(2)原因不明的痴呆患者应常规行梅毒血清学及脑脊液检查;(3)驱梅结合对症治疗大多近期疗效好;(4)需长期随访观察远期疗效.

Abstract：

Objective To study the clinical features, therapy and prognosis of neurosyphilis typically manifested as dementia to improve its diagnosis and treatment. Methods A retrospective analysis of patients with neurosyphilis typically manifested as dementia, searched in Medline and Chinese Biomedical Literature Datebase (CBM) from 1989 to 2010, was performed. Results Forty-four studies involving 62 patients (61 cases of general paresis and 1 case of syphilitic psychoneurosis) were evaluated;the clinical features of them included the follows: male are more common;most of them had insidious onset;memory impairment and personality changes were the first common symptoms;diffuse cerebral atrophy was found in MRI and CT;serum and cerebrospinal fluid (CSF) syphilis antibody reaction was positive with some exceptional case;definite diagnosis was difficult;after anti-syphilitic therapy, symptoms could be improved more or less in a short time;and evidence of long-term prognosis was insufficient. Conclusion Both general paresis and syphilitic psychoneurosis could cause dementia. Dementia patients should be given serum and CSF syphilis antibody examination routinely if the causes of dementia are unknown. Anti-syphilitic and symptomatic treatments mostly enjoy good curative effects in a short term. Close follow-up is necessary in observing the forward effects.     

麻痹性痴呆的临床特征与诊断(附2例报告)

目的探讨麻痹性痴呆的临床特征,以及实验室及影像学检查在诊断中的价值。方法回顾性分析2例麻痹性痴呆患者的临床资料,并结合文献进行讨论。结果主要临床表现为隐匿起病,进行性加重性痴呆、精神障碍、癫痫发作等;2例患者均被误诊。血清及脑脊液快速血浆反应素环状卡片试验（RPR）阳性,梅毒螺旋体明胶凝集试验（TPPA）阳性,头颅MRI主要表现为弥漫性脑萎缩。结论麻痹性痴呆的临床表现复杂多变,早期误诊率高;诊断主要根据临床特点、血清学及脑脊液检查综合考虑。     

Creutzfeld-Jakob病的临床及脑电图特点

目的探讨克雅（氏）病（Creutzfeld-Jakob disease,CJD）的临床表现及脑电图特点。方法回顾分析10例CJD患者的临床表现及脑电图特点。结果CJD患者以进行性痴呆和肌阵挛最常见,首发症状多为抑郁、失眠、头痛、头晕、记忆力减退及行走不稳。典型脑电图呈阵发周期现象,周期波为高幅尖波、慢波、三相波或多相波,脑电图异常程度随患者病情加重而持续性加重。MRI异常表现为基底节区可见等T1/长T1、长T2信号,双侧基底节对称性钙化及脑皮质萎缩,部分脑脊液蛋白质增高。结论结合典型临床表现,动态脑电图可为CJD的早期临床诊断提供依据。     

Correlation between diffuse EEG abnormalities and cerebral atrophy in senile dementia.

Thirty-five elderly patients were investigated because of clinical signs of dementia. The presence or diffuse cerebral atrophy, and its severity, were determined by the use of computed tomography (CT scan). All of the patients were also examined by electroencephalography (EEG), and the presence of diffuse abnormalities, especially diffuse slowing, was noted. Specifically, patients with normal or near-normal EEGs were compared with those with severe diffuse slowing. No correlation between the presence or severity of diffuse EEG abnormalities and the degree of cerebral atrophy as measured by CT scan was found. Though the EEG is clearly identifying physiological dysfunction of nerve cells in demented patients it does not appear to be reliable tool for the prediction of diffuse cerebral atrophy in this population.     

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.     

Seizure occurrence,EEG, and magnetic resonance imaging findings in 61 patients with acquired immunodeficiency syndrome

Sixty-one human-immunodeficiency-virus (HIV) seropositive patients at various infectious stages who underwent at least one EEG examination were retrospectively studied. The seizure occurrence and the EEG as well as the magnetic resonance imaging (MRI) findings of these patients were related to the different clinical stages. Results show that the overall occurrence of seizures was 65%. Abnormal EEG was found in 93% of patients. The most common EEG abnormality was predominantly anterior symmetric slowing, which was present in 40% of patients having focal EEG slowing on their EEGs. MRI was abnormal in 89% of 54 patients. Cerebral atrophy was the MRI finding in 57% of patients. Cerebral atrophy only was present in 35%, a single focal lesion in 17%, and multiple lesions without atrophy in 15%. A focal lesion with atrophy was found in 17% and multiple lesions together with cerebral atrophy in 5%. There was good correlation among severity of the disease, occurrence of seizures, and positive EEG and MRI findings.     

麻痹性痴呆的MRI表现(附32例报道)

目的 探讨麻痹性痴呆(GPI)的MRI特征和诊断价值,提高对GPI患者MRI表现的认识.方法 中山大学第三附属医院放射科自2006年5月至2010年11月共诊断GPI患者32例,回顾性分析患者的临床资料并总结GPI的MRI表现.结果 本组患者的MRI表现分为两型:脑萎缩型(30例)和脑肿胀型(2例),其中脑萎缩型GPI的MRI表现为:(1)以颞叶、额叶、海马、胼胝体萎缩为主,脑白质萎缩较脑皮质萎缩明显;(2)杏仁体及海马形态异常及伴T2信号增高;(3)皮层/皮层下"脑回状"T2信号增高,以岛叶多见;(4)双侧豆状核对称性T2信号减低;脑肿胀型GPI的MRI表现为弥漫型或局灶型.结论 GPI的MRI表现多样,但具有一定特征性,结合临床表现和相关实验室检查结果可作出正确诊断.

Abstract：

Objective To evaluate the MRI findings in patients with general paresis of insane (GPI) to enhance the understanding of MRI diagnosis of this disease. Methods The clinical data and MRI findings of 32 patients with GPI, admitted to our hospital from May 2006 to November 2010, were retrospectively analyzed. Results The MRI findings of GPI were mainly divided into 2 types: cerebral atrophy (n=30) and cerebral swell (n=2). The major MRI findings in the type of cerebral atrophy included white cerebral atrophy in the temporal lobe, the frontal lobe, the hippocampus and the corpus callosum, morphological changes and T2 hyperintensity in the amygdaloid body and the hippocampus, gyral T2 hyperintensity in the cortex and subcortex, and T2 hypointensity in the lenticular nucleus. The MRI findings in the type of cerebral swell manifested as suffused and focal types. Conclusion The MRI findings in GPI are multiple with some characteristic manifestations. Diagnosis must be made through the combination of imaging features with clinical data and related laboratory tests.     

Acquired epileptiform opercular syndrome: a case report and results of single photon emission computed tomography and computer-assisted electroencephalographic analysis

We report here a girl aged 5 years 3 months with cryptogenic localization-related epilepsy who showed a prolonged episode characterized by dysarthria, dysphagia, drooling and paresis of the right arm associated with almost continuous diffuse sharp-slow wave complexes during sleep. These symptoms were not directly related to seizures or to each sharp-slow wave complex revealed by examination during the video electroencephalographic (EEG) recording. The interictal single photon emission compute tomography showed a localized high perfusion area in the left posterior frontal region. The introduction of clonazepam completely controlled the clinical symptoms as well as the EEG abnormality within 2 weeks. After 4 months of remission, a similar episode recurred which was associated with aggravation of EEG. The clinical and EEG characteristics of this patient were identical to those of acquired epileptiform opercular syndrome (AEOS), a newly proposed epileptic syndrome, in which a transient operculum syndrome develops in association with continuous spike-and-wave activity during slow sleep (CSWS). Computer-assisted EEG analysis demonstrated that the epileptic EEG focus was located in the left sylvian fissure, and produced secondary bilateral synchronous sharp-slow complexes. The present study further supports the hypothesis that the electrical interference by CSWS creates bilateral opercular dysfunction through the mechanism of secondary bilateral synchrony, thus producing AEOS.     

The relationship between slow and sharp waves (spikes) and also clinical seizures.

This study investigated the relationship between slow waves and sharp waves (spikes) and also clinical seizures in 255 patients with 694 EEGs over a 25-yr period. Slow waves were quantified into five groups, sharp waves into three groups and clinical seizures also into three groups. In general, as clinical seizures increased, the number of patients with many discharges increased and the number with only rare discharges decreased. Also, as patients became seizure free, there was a decreasing incidence of many sharp waves and an increasing incidence of only rare sharp waves. No relationships could be found in patients with a typical number of discharges or a steady number of seizures. Thus, a relationship between sharp waves and seizures was found mainly when there were changes in these variables. For sharp and slow waves, rare discharges were most often associated with mild slowing, while many discharges were most often related to a marked degree of slow wave abnormality. The combination of slow and sharp waves together, compared with only one type of EEG abnormality, was associated with more clinical neurological symptoms, especially a mental status change. The EEG groups were divided into four types of findings of slow and sharp waves, appearing in at least a first and/or second record. The results from these four EEG groups allow for a prediction of the findings to be found in a second record, based on the results of the first EEG. In general, there was a relationship between more slow waves, more sharp waves and more seizures. Also minimal slowing and rare discharges on the first record tended to disappear in the next EEG.     

脑囊虫病人头痛发作的病因、临床表现及脑电图分析

目的探讨脑囊虫病人头痛发作的病因、临床特点及脑电图特征。方法对410例脑囊虫病人头痛发作的病因、临床表现、分型及脑电图资料进行统计分析。结果410例脑囊虫病人头痛发作的病因为颅内压增高和脑膜炎。以青壮年为主(72.20%),男性多于女性,农民发病率最高(73.66%)。脑室型头痛(9.51%)以发作性为特点,伴有Brun’s征;脑膜型头痛(9.02%)以持续性头痛为特点,伴有发热;脑实质型头痛(62.93%)以颅压高性或非颅压高性头痛为特点;混合型头痛以颅压高性为特点。脑电图检查正常87例(21.22%),异常323例(78.78%)。异常脑电图中207例(64.09%)主要表现为弥漫性慢波活动,116例(35.91%)为局限性慢波活动,27例在异常背景上有散在或阵发性棘、尖波或棘、尖慢综合波。结论头痛是脑囊虫病人常见症状,颅内压增高和脑膜炎是导致头痛的主要原因;脑电图表现以弥漫性或局限性慢波活动为主。     

Occlusive arterial disease of the child and young adult. Clinical electroencephalographical analysis of 26 cases

26 patients suffering from acute arterial disease, predominant in childhood and young adults, have been studied. Convulsive symptom and electroencephalographic (EEG) findings are especially analyzed. The series are grouped following the Hilal classification, based on angiographical aspects. The incidence and etiological facts as well as the clinical and the angiographical findings, are summarized. The EEG analysis shows the high incidence of localized or lateralized abnormalities (23 out of 26), closely related with the clinical signs. However, there is no close relationship between these findings and the conscious state of the stage of the disease. An attempt is made to correlate the added diffuse and/or paroxysmal activities with the brain damage suspected by the angiographical signs. Seizures are present in 10 cases, 9 of them as initial symptoms predominantly of the focal type. There seems to be no relationship between the incidence and type of fits and the angiographical findings. Follow-up study shows that seizures do not modify the immediate course of the disease nor the persistence of this sequela in 9 of the controlled patients. The histopathological findings of cerebral vessel involvement are reported.     

Cerebral computed tomography and electroencephalography compared with neuropsychological findings in systemic lupus erythematosus

Central nervous system involvement was evaluated in 36 patients with systemic lupus erythematosus (SLE) using cerebral computed tomography (CT), electroencephalography (EEG), and a neuropsychological test battery. The purpose was to investigate whether brain dysfunction as assessed by comprehensive neuropsychological investigation is associated with findings of routine investigation methods such as CT and EEG which are available in most hospitals. Abnormal EEG was found in 19%, and CT revealed cerebral atrophy in 47% of SLE patients. Few neuropsychological functions were affected by the presence of abnormal EEG, cerebral atrophy, or infarcts. Significant associations were found only between cortical atrophy and impairment of tactile spatial problem-solving and motor dexterity, and between cortical infarcts and motor dexterity in the dominant hand. The value of conventional EEG in assessing cerebral SLE is negligible, except for identifying epileptic activity and focal pathology. Cerebral CT has little relevance in predicting brain dysfunction as established by neuropsychological assessment in SLE, except for detecting cortical atrophy and infarcts. Received: 14 September 1998 Received in revised form: 19 January 1999 Accepted: 11 February 1999     

Relationship between MRI findings and prognosis for patients with general paresis

MRI was performed in 7 patients with general paresis before or at a very early stage of treatment. A large dose of antibiotics, mainly penicillin, was given to all patients, and the effects of treatment, the patients' outcome, and MRI findings were investigated. Three of the 7 patients had MRI findings of atrophy of the medial temporal lobe including the hippocampus. In the medial temporal lobe atrophy group, a personality change or general dementia remained even after the treatment was completed, and outcome in social functioning was poor. Medial temporal lobe atrophy may be a poor prognostic sign in general paresis.     

Clinical and magnetic resonance imaging findings of HIV-Negative patients with neurosyphilis

There have been no serial studies about neuroradiological findings of neurosyphilis in the literature. There have been only case reports concerning HIV negative patients with neurosyphilis. We present 8 HIV negative neurosyphilis patients two of whom are women. The mean age of the patients was 48 years±12.37. Five of the 8 patients had general paresis, two optic atrophy and one multiple cranial neuropathies. The CSF findings were quite similar in 6 of 8 patients. In half of the patients cranial MRI showed mild cerebral atrophy. Nonspecific hyperintense small foci in 3 patients are thought to be related to syphilis. Hyperintensity involving bilateral medial and anterior temporal regions more prominent on the left side was seen in one of the patients with general paresis. This finding may be due to cytotoxic edema associated with status epilepticus and may mimic herpes simplex and other limbic encephalitides. Though not typical, certain MRI findings guides for the diagnosis of neurosyphilis. Received in revised form: 5 April 2006     

麻痹性痴呆误诊的原因分析

目的探讨麻痹性痴呆易被误诊的可能原因,提高临床诊断率。方法回顾性分析14例曾被误诊的麻痹性痴呆患者的临床资料。结果以不典型的精神症状群首发而被误诊为功能性精神障碍10例,其中误诊例次率最高的是精神分裂症占47．3％,其次是躁狂症占31．6％;以进行性加重的痴呆为主要首发症状而被误诊为阿尔兹海默病的2例及血管性痴呆1例;以酒依赖伴有痴呆样症状为主被误诊为酒精所致精神障碍的1例。〈40岁的占总数的28．5％。否认或故意隐瞒治疗史9例,根本不知情5例。误诊时处于发病早期无神经系统的阳性体征8例;处中晚期有神经系统阳性体征且呈不同程度表现的共6例,其中仅1例伴有特异性阿-罗氏瞳孔特征。14例辅助检查均不够完善,均未及时进行相关梅毒血清学检查。结论麻痹性痴呆易被误诊的首要原因是首发精神症状不典型,其次是冶游史易被隐瞒、早期神经系统阳性体征不明显或中晚期缺乏阿-罗氏瞳孔特异性体征、辅助检查不够完善和及时。