脑膜血管型神经梅毒的诊治(附4例报道及文献复习)

目的分析脑膜血管型神经梅毒的临床表现、实验室检查和神经影像学检查特点及其治疗和预后,提高对该病的诊治水平。方法对我院收治的4例脑膜血管型神经梅毒患者的临床资料、实验室检查、神经影像学检查结果及诊治经过进行回顾性分析。结果 4例患者中3例男性,1例女性,均以脑卒中样表现起病,脑血管病危险因素较少,影像学检查无特异性,血清及脑脊液血梅毒螺旋体明胶凝集试验(TPPA)和快速血浆反应素试验(RPR)阳性以确诊,大剂量青霉素治疗预后较好。结论脑膜血管型神经梅毒临床表现及神经影像学检查无特异性,容易误诊,对没有明确病因或病因较少的脑梗死患者,及早进行梅毒血清学实验和脑脊液检查,大剂量青霉素治疗有效。

The Diagnosis and Treatment of Meningovascular Neurosyphilis (A Report of 4 Cases and Literature Review).

Objective To analyse the features of clinical manifestations ,laboratory findings and neuroimaging examination of meningo-vascular neurosyphilis as well as its treatment and prognosis so as to improve the diagnostic and therapeutic ability of this disease . Methods The clinical data , laboratory and neuroimaging findings ,process of diagnosis and treatment of 4 meningovascular neu-rosyphilis cases in our hospital were analysed retrospectively .Results Of the 4 patients ,3 were male ,1 was female .They all had stroke_like manifestation onset with very few risk factors of cerebrovascular disease and nonspecific symptoms in imaging examination , and diagnosed with TPPA and RPR positive in serum and cerebrospinal fluid .When cured by a high dose of penicillin ,the patients had favorable prognosis .Conclusions Since the clinical manifestations and neuroimaging examination findings of meningovascular neu-rosyphilis have no specificity ,it can be misdiagnosed easily .Therefore ,patients with cerebral infarction who have little or no definite etiology ,syphilis serological test and cerebrospinal fluid examination should be performed as early as possible ,and a high dose of penicillin would be an effective treatment .