神经梅毒的临床特征与诊断分析

目的：分析神经梅毒的分型和临床特征及提供早期诊断依据。方法：回顾性分析经临床和实验室检查确诊的18例神经梅毒病人的有关临床资料。结果：神经梅毒的临床特征包括：(1)急性、亚急性起病为主；(2)临床以间质型，尤其是以脑卒中起病常见，症状元特异性；(3)血清学检查以梅毒螺旋体血凝试验(TPHA)及快速血浆反应素试验(RPR)特异性较高；(4)脑脊液检查表现为压力增高(42．9％)、蛋白增高(81．2％)及细胞数增高(56．3％)；(5)头颅CT、MRI表现与高血压、动脉硬化所致脑梗死不同，为多发、散在病灶。结论：神经梅毒早期误诊率高，临床表现与分型密切相关，实验室及影像学检查是诊断的重要依据。     

MRI in patients with general paresis

Few cases of MRI in neurosyphilis have been reported. We examined the value of MRI in patients with general paresis; MRI was performed on four HIV-negative patients with parenchymatous neurosyphilis. It demonstrated frontal and temporal atrophy, subcortical gliosis and, in one patient, increased ferritin in the basal ganglia. The progression of the lesions on MRI correlated well with the neuropsychiatric disturbances. The MRI findings correlated with the wellknown neuropathological findings. This combination of pathological findings in neurosyphilis has not been described before and we suggest that MRI is of prognostic value in patients with general paresis.     

神经梅毒发病的危险因素及预测因素研究进展

神经梅毒是梅毒螺旋体侵犯神经系统而导致的较严重的临床阶段,伴或不伴HIV感染的梅毒患者发生神经梅毒的危险因素及预测因素有所不同。HIV阴性梅毒患者发生神经梅毒的危险因素主要包括性别、年龄、梅毒感染阶段、治疗情况等;预测因素包括血清学滴度、脑脊液一些指标的变化及是否伴有神经系统或眼科症状等。HIV病毒载量及CD4 ...     

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。     

Incidence and Clinical Presentation of Neurosyphilis: A Retrospective Study of 81 Cases

Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1965–2005). The investigation was based on the retrospective review of patients with neurosyphilis hospitalized in our hospital from 1965 to 2005 (period A: 1965–1984 and B: 1985–2005). Eighty one patients with neurosyphilis were studied. Typical forms represent 68.6% of cases of neurosyphilis in period A. In period B, 85.7% of the cases are presented with atypical clinical patterns. Typical forms of the disease were no longer common, while atypical and masked clinical patterns prevailed. Neuropsychiatric symptoms were the most common manifestations of the disease.     

妊娠梅毒219例随访分析

目的：分析广州市番禺区妊娠梅毒筛查、诊治、随访情况,为妊娠梅毒管理工作提供改进依据。方法采用回顾调查分析法,对番禺区2011年10月至2013年9月筛查103665例孕妇新发现的219例妊娠梅毒患者随访情况进行统计。结果103665例孕妇中确诊妊娠梅毒219例,妊娠梅毒筛查阳性发生率为0.21％,均为潜伏梅毒;176例患者在孕期进行了1个疗程的治疗,其中33例积极接受2个疗程规范治疗;40例未治疗;3例因电话空号、关机或拒绝无法随访;先天梅毒共14例,发生率为6．4％。结论妊娠梅毒是一种严重母婴传播疾病,经过规范治疗、密切随访、加强宣传教育,提高患者依从性可降低先天梅毒的发生。     

Neurosyphilis presenting with focal middle cerebral artery stenosis and acute ischemic stroke: A case report

Despite widespread screening and active management of syphilis infection, the rate of secondary and tertiary syphilis has increased over the past decade in the United States, especially with human immunodeficiency virus co-infection. We report a case of ischemic strokes in the middle cerebral artery (MCA) territory with focal stenosis of the left M1 segment of the MCA resulting from neurosyphilis with manifestation of subacute intermittent right-sided hemi-body numbness and transient word finding difficulties in a young adult with no prior known history of syphilis or significant cerebrovascular risk factors. A diagnostic cerebral angiogram was done which was initially concerning for possibility of reversible cerebral vasoconstriction syndrome (RCVS). The serum Treponema pallidum RPR testing resulted positive (1:32 titer) as well as subsequent reactive cerebrospinal fluid (CSF) VDRL test (ratio, 1:8). The patient was treated with intravenous ceftriaxone as well as verapamil and recovered without any residual deficits. To the best of our knowledge, this is the first reported evidence of possible RCVS in a case of neurosyphilis and related ischemic stroke. This case underscores the importance of evaluation for syphilis in young patients with fewer known vascular risk factors, who present with an ischemic stroke. Given the higher rates of stroke recurrence in neurosyphilis relative to few other stroke risk factors, early diagnosis, and treatment is furthermore essential to prevent disease progression.     

Frequency of Treponema pallidum invasion into cerebrospinal fluid in primary or secondary early-stage syphilis

Frequency of Treponema pallidum invasion into cerebrospinal fluid (CSF) has not been clear at this present. Since it is impossible to culture T. pallidum in vitro at this present, we need molecular based-approach to detect it in CSF. Additionally, neurosyphilis is usually a late sequela, however it might result in asymptomatic neurosyphilis even at primary or secondary syphilis. This study was to reveal the frequency of T. pallidum invasion into CSF especially at primary or secondary syphilis with polymerase chain reaction (PCR) test.All patients were visited the Aichi Medical University Hospital or Izumi ladies' clinic between 2016 and 2017. Clinical CSF samples were collected from patients with early and late stages of syphilis. The PCR was done using primers targeting the tpN47gene.CSF samples were collected from 9 patients (4 patients with primary syphilis, 3 with secondary syphilis, and 1 early latent syphilis and 1 with late latent syphilis). PCR showed positive reaction in 2 of 7 (28.6%) primary and secondary syphilis patients, in 1 of 1 (100%) early latent syphilis patients, and in 1 of 1 (100%) late latent syphilis patients.Despite its lack of sensitivity for use alone as a diagnostic test, this PCR test should be preferred for the diagnosis of neurosyphilis. Because, T. pallidum was detected in the 28.6% CSF of patients at primary and secondary syphilis, which indicated that they invade the central nervous system from the early stages of infection. However, studies in a larger population are required to confirm these preliminary results.     

神经梅毒的研究现状和进展

神经梅毒是由苍白螺旋体（梅毒螺旋体）侵犯软脑膜和脑实质所致的持续感染。近20年来梅毒在全国各地又重新出现,并有逐年增多的趋势[1]。在未治的HIV（+)梅毒患者中,神经梅毒发生率为23.5%,它可以发生在梅毒感染的各个时期,现阶段根据患者病史,特征性的临床表现及敏感性特异性逐渐增高的梅毒血清学,CSF联合检查（尤其是CSF检查）提高了神经梅毒的早期检出率。青霉素仍是治疗神经梅毒的首选有效药物。该研究拟就神经梅毒的诊断和治疗方面的研究进展做一综述。     

神经梅毒临床误诊病例分析

目的分析神经梅毒误诊原因，提高诊断的准确率。方法回顾性分析2001年1月-2004年2月曾经在院外误诊的12例神经梅毒患者的临床资料及误诊原因。结果12例患者中2例脑膜血管梅毒者被误诊为动脉硬化性脑梗死，2例脑膜梅毒被误诊为结核性脑膜炎和动脉瘤，2例脊髓痨被误诊为多发性神经炎，6例全身麻痹性痴呆被误诊为阿尔茨海默病、血管性痴呆、慢性酒精中毒性脑病、急性病毒性脑炎、路易体痴呆和帕金森病合并痴呆。误诊原因主要为：临床问诊忽略了患者的冶游史以及患者和家属有意隐瞒病史；体格检查不全面和定位诊断错误；全身性神经梅毒的临床表现不典型；神经梅毒的临床表现复杂多样，临床医师对其认识不足，病因诊断时考虑不充分(误诊的最主要原因)。结论神经梅毒临床表现较为复杂，临床医师对此应有充分认识，对可疑病例应注重询问相关病史，认真进行全面体格检查及特异性的血清学、脑脊液检查，以提高对本病诊断的准确率。