以共济失调为首发表现的神经梅毒临床特征分析

目的探讨以共济失调为首发表现的神经梅毒患者临床特征。方法选取以共济失调为首发表现的神经梅毒9例(神经梅毒组),以共济失调为主要表现的脑梗死患者19例(脑梗死组),回顾性分析神经梅毒患者的临床表现、脑脊液和血清梅毒检查结果、脑电图、核磁共振结果,应用青霉素或者头孢曲松治疗神经梅毒患者,将治疗前后血清和脑脊液梅毒检查结果对比,对比神经梅毒组和脑梗死组患者共济失调量化评分结果。结果大多数共济失调表现累及双下肢,少数累及偏侧肢体或者双上肢。在静态姿势和步态项目的评分中,神经梅毒组患者睁眼时身体站立能力差、睁眼和闭眼时身体摇晃程度明显。在动态肢体协调项目的评分中,脑梗死组患者的跟膝胫试验(动作分裂和意向性震颤)完成差、指鼻试验完成差、绘阿基米德螺旋图形完成差,总体动态肢体协调完成差。所有神经梅毒组患者的梅毒螺旋体明胶凝集试验(TPPA)、梅毒甲苯胺红不加热血清试验(TRUST)、性病研究实验室试验(VDRL)阳性,治疗后滴度均开始逐步下降。头颅MRI主要以显示基底节区急性脑梗死、脑内多发陈旧性梗死、脑沟、脑裂和脑池增宽,脑室扩大,颞叶海马萎缩为主。脑电图以中﹣重度异常为主。脑脊液白细胞计数均高于正常,8例患者脑脊液蛋白质含量增高。结论对于合并有精神异常和认知障碍,累及双上肢或者双下肢或者偏侧肢体、以损害静态姿势和步态为主的共济失调患者,需要考虑神经梅毒的可能。

Clinical features of neurosyphilis with ataxia as the initial manifestation: An analysis of nine cases

Objective To investigate the clinical features of neurosyphilis patients with ataxia as the primary manifestation. Methods A total of nine cases of neurosyphilis (neurosyphilis group) and nineteen cases of cerebral infarction (cerebral infarction group), both with ataxia as the primary manifestation, were enrolled. The clinical manifestations, cerebrospinal fluid (CSF) and serum test results for syphilis, electroencephalogram (EEG), and magnetic resonance imaging (MRI) results were retrospectively analyzed. The patients with neurosyphilis were treated with penicillin or ceftriaxone, and their CSF tests results for syphilis were compared before and after treatment. The quantitative ataxia test results were compared between the neurosyphilis group and cerebral infarction group. Results Ataxia involved both lower extremities in most patients and unilateral extremities or both upper extremities in a few patients. In the static posture and gait analysis, the patients in the neurosyphilis group showed poor standing ability with eyes open and obvious body shaking with eyes open and closed. In the limb movement coordination tests, the patients in the cerebral infarction group showed poor performance in the heel-knee-tibia test with uncoordinated movements and intentional tremor, the finger-nose test, drawing Archimedes spiral, and overall coordination of limb movements. All the patients in the neurosyphilis group showed positive results in the Treponema pallidum particle agglutination test, toluidine red unheated serum test, and Venereal Diseases Research Laboratory test, and the titer began to decrease gradually after treatment. Head MRI mainly showed acute cerebral infarction in the basal ganglia, multiple old infarcts in the brain, widening of the cerebral sulci, fissures, and cisterns, ventricular enlargement, and hippocampal atrophy in the temporal lobe. EEG showed moderate to severe abnormalities. The CSF leukocyte count was higher than the normal value in all the patients, and eight patients showed an increase in CSF protein content. Conclusions For patients with ataxia and featuring mental disorders, cognitive impairment, involvement of both upper or lower extremities or unilateral extremities, and poor performance in static posture and gait, the possibility of neurosyphilis needs to be considered.