脊髓痨11例临床特点及诊断依据分析

目的:综合分析脊髓痨的临床特征及辅助检查结果,说明体感诱发电位在诊断治疗中的作用。方法:回顾性分析近5年我院及文献报道确诊的11例脊髓痨患者的临床症状、神经影像学、实验室检查及神经电生理检查特点。结果:(1)脊髓痨的主要临床特征行走不稳、下肢深感觉障碍、跟膝反射减弱或消失及闭目难立试验阳性。(2)全部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(单核细胞为主)。(3)肌电图不支持周围神经受损。(4)胸段脊髓核磁共振成像(MRI)无特殊发现。(5)胫神经体感诱发电位4例有异常改变。结论:临床表现及实验室检查是确诊脊髓痨的重要依据;脊髓痨MRI检查无特殊改变。短潜伏期体感诱发电位(SEP)对诊断、疗效判断有意义。

Analysis of the clinical characteristics and diagnosis evidence of tabes dorsalis

Objective: To detect what is the effect of somatosensory evoked potentials(SEPs) in tabes dosalis, while we analysised the clinical characteristics and laboratory data of it. Methods: We retrospectively studied 11 patients with tabes dorsalis in our hospital or others in recent 5 years, whose clinical symptom, neuroimaging, laboratory and neuroelectrophysiological features. Results: (1) The clinical characteristrics of tabes dorsalis is impaired vibratory and position sense in feet and legs, absent tendon reflexes at knee and ankle, gait ataxia and Romberg sign. (2) Serum and cerebrospinal fluid (CSF) syphilis antibody reaction of 11 patients showed positive;CSF protein content was increased, cells increased(with monocyte mainly).(3) There is not evidence of impaired peripheral nerve in EMG. (4) The thoracic MRI of the patients is normal.(5)Tibial nerve SEPs is abnormal in 4 patients. Conclusion: The clinical characteristics and laboratory data is the important evidence of diagnosis of tabes dorsalis. The MRI of tabes dorsalis is normal. Analysis of tibial nerve SEPs provides a useful tool for the diagnosis of neurosyphilis and the evaluation of the extent to which neurosyphilis has progressed.