麻痹性痴呆

神经梅毒（NS）是梅毒螺旋体（TP）侵犯脑膜和（或）脑实质引起的一种慢性中枢神经系统感染性疾病,而麻痹性痴呆（GPI or PD）则是神经梅毒最常见的类型。1882年,Bayle首先报告麻痹性痴呆,1913年,Noguehi和Moore从神经梅毒患者的脑组织中分离获得梅毒螺旋体,得以明确其病因。在西方国家,麻痹性痴呆较少见,我国曾在20世纪50年代相对常见,至60年代后基本销声匿迹。     

麻痹性痴呆

近年来随着梅毒的发病率的升高 ,神经梅毒的发病亦有增加 ,麻痹性痴呆作为其最严重的一种类型应该引起足够重视。麻痹性痴呆因是一种可治的痴呆 ,及早诊断 ,对其预后有积极的意义。     

麻痹性痴呆临床特征分析

目的分析麻痹性痴呆的临床特征。方法回顾性分析13例麻痹性痴呆患者的临床表现、辅助检查及治疗。结果本组患者以认知及精神症状为主要表现;简易智能状态检查量表(MMSE)评分平均12±3分;所有患者血清和脑脊液TRUST及TPPA试验阳性,部分患者脑脊液白细胞数和蛋白含量增高;头颅MRI示脑萎缩;12例患者经大剂量青霉素治疗后有好转。结论麻痹性痴呆容易误诊;大剂量青霉素治疗有效。     

麻痹性痴呆一例报告

患者男性,47岁,2006年8月17日入院.2月前出现记忆减退,性格改变,原内向性格变为言语多,且自言自语,爱管闲事,行为异常,经常捡些垃圾回家.     

麻痹性痴呆1例

患者,女性,50岁,近6个月来无明显诱因出现言语减少,胃纳不佳,活动减少,在区精神卫生中心就诊,诊断为“抑郁症”。予以路滴美75mg／d治疗,病情有所改善后自行停药,遂出现行为异常,丢三拉四,言语零乱,夜眠差,头晕、心慌,予以奥麦伦治疗,疗效欠佳,为进一步治疗住入我院。个人史：两年前因丈夫有外遇离异,离婚后无不洁性交史。既往史、家族史无特殊。     

麻痹性痴呆96例临床分析

目的提高对麻痹性痴呆临床特征的认识,避免误诊。方法回顾性分析96例麻痹性痴呆患者的临床资料、相关检查、治疗及预后。结果患者表现不同程度的痴呆、精神病样症状及多种神经系统损害的症状和体征;头颅MRI有特征性改变;血液和脑脊液RPR和TPPA均阳性;大剂量青霉素治疗有效。结论麻痹性痴呆临床表现多种多样,容易误诊,需临床医师提高警惕。     

麻痹性痴呆12例临床分析

目的探讨麻痹性痴呆(GPI)患者的临床表现,实验室检查、影像学、脑电图特征以及诊断、治疗及预后。方法回顾性分析经临床和实验室确诊的12例GPI患者的相关资料。结果GPI患者临床以智能障碍、精神异常、癫痫最常见。12例患者血清甲苯胺红凝集试验(TRUST)和梅毒螺旋体明胶凝集试验(TPPA)均( ),脑脊液TPPA均( ),而TRUST( )9例。头颅MRI检查结果示大脑皮质萎缩。3例以肢体抽搐为表现者脑电图可见广泛中高幅尖慢波,余脑电图为弥漫性慢波。经抗梅毒治疗,痊愈4例,显效5例,好转3例。结论GPI现已是我国神经梅毒分型中极常见类型,多见于中年男性,临床表现多变,早期误诊率高,早期发现、及时正规治疗预后好。     

麻痹性痴呆的临床及影像特点

目的:分析麻痹性痴呆(GPI)的临床及影像特征及提供早期诊断依据。方法:回顾性分析经临床及实验室确诊的1例麻痹性痴呆患者的有关临床资料。结果:麻痹性痴呆早期以认知及精神症状为主要表现,影像上主要为脑室扩大,实验室检查有特征性改变。结论:麻痹性痴呆早期临床容易误诊,应重视梅毒血清和脑脊液抗体的检查,结合CT、 MRI可以诊断,大剂量足疗程青霉素治疗能取得显著疗效。     

麻痹性痴呆(附2例报告)

目的 探讨麻痹性痴呆（GPI）的临床表现、实验室检查、影像学改变和治疗。方法 回顾性分析2例GPI患者的临床资料结果2例患者均为男性,以记忆力下降和精神障碍为主要临床表现,1例出现内脏危象,血清及脑脊液快速血浆反应素环状卡片试验（RPR）、梅毒螺旋体明胶凝集试验（TPPA）均（＋）,MRI检查均有脑室扩大经驱梅治疗后,2例患者病情均明显好转。结论 GPI多见于中年男性,误诊率高,对不明原因的年轻痴呆患者,应想到GPI的可能,及时诊断、积极治疗对其预后有重要意义。     

麻痹性痴呆8例临床分析

麻痹性痴呆（general paresis of insane,GPI）是神经梅毒的一种类型,是梅毒螺旋体侵犯中枢神经系统实质而导致的神经精神功能障碍,近年来发病率有逐年增高的趋势.现将我院2000年1月～2006年2月共收治的8例GPI进行分并讨论其临床特点及诊断。[第一段]     

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。     

Note on Metrazol in General Paresis

Abstract

This case study describes the association of Pseudologia Fantastica (PF) and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) in a 14-year-old girl. PF is seen in a number of diagnostic entities, but has not previously been reported in PDD spectrum disorders. Treatment implications are discussed along with a formulation of the psychological and cognitive functions of PF in a person with a PDD diagnosis.     

Parkinson's Disease of Post-eneephalitic Type Following General Paresis:— An Autopsied Case —

Abstract: A clinico-pathological report is given of a case of Parkinson's disease following a general paresis. A 66-year-old male, with no previous history of febrile disease or viral encephalitides, developed a dementing illness. The general paresis was diagnosed from serological studies at the age of 45. He underwent a series of penicillin plus fever therapies as treatment for neurosyphilis. He also developed generalized rigidity and slow mobility 12 years after the diagnosis of general paresis. An anti-Parkinson drug was givenj Finally he fell in a state of muteness and became bedridden. He had been hospitalized for 21 years and died from bronchopneumonia. The pathological findings were strikingly similar to post-encephalitic parkinsonism in addition to a healed state of general paresis. They consisted of a widespread nerve/ cells loss, gliosis and the presence of Alzheimer's neurofibrillary tangles in the substantia nigra. In the cerebral cortex, a diffuse loss of nerve cells and the presence of a weak positive iron reaction were observed. The coexistence of general paresis and post-encephalitic parkinsonism is unusual and the authors discussed the etiological relationship between the two different conditions.     

Worsened MRI Findings During the Early Period of Treatment with Penicillin in a Patient with General Paresis

A 52‐year‐old man was diagnosed with general paresis, whose HIV antibodies were negative. After initiation of treatment with penicillin on the first day, no obvious clinical Jarisch‐Herxheimer reaction was found. However, 6 days after treatment, the patient was found more irritable and was unable to fall asleep at night. On the seventh day, worsened magnetic resonance imaging (MRI) abnormalities in the bilateral medial and anterior temporal lobes were unexpectedly discovered. These worsened MRI abnormalities improved quickly after the addition of dexamethasone treatment. We consider that these transient and slight mental symptoms may be associated with the transiently worsening phenomenon in cerebral MRI findings during the early period of treatment with penicillin. This indicates that some nonspecific inflammatory process has happened in the early stage of treatment, which necessitates the use of corticosteroids after the occurrence of systemic or mental symptoms.