中枢神经系统梅毒性血管炎的临床观察(附4例报告)

目的分析中枢神经系统梅毒性血管炎的临床特征并为早期诊断提供依据。方法回顾分析我院收治的4例梅毒性血管炎患者的临床资料。结果中枢神经系统梅毒性血管炎的临床特征：①可表现为亚急性或慢性起病,进行性发展,出现与病变部位相关的多种临床症状;②腰穿检查可发现脑脊液白细胞及蛋白轻度升高,糖及氯化物无明显变化;③血清及脑脊液梅毒快速血浆反应素试验（RPR）与梅毒螺旋体明胶凝集试验（TPPA）阳性是确诊的必要依据;④影像上病灶多变、呈游走性;⑤脑血管造影及组织病理学检查具有重要诊断意义,但无特异性。结论中枢神经系统梅毒性血管炎的诊断应结合个人生活史、实验室检查及影像学检查结果,临床上对于脑卒中,尤其是无高血压、糖尿病等脑血管病危险因素的青年卒中患者,要高度重视血清及脑脊液梅毒抗体检测。

A clinical research of syphilitic vasculitis in the central nervous system(report of 4 cases)

Objective To analyze the clinical features of syphilitic vasculitis in the central nervous system and provide evidence for early diagnosis. Methods A retrospective study was conducted among 4 patients diagnosed as syphilitic vasculitis in Xuanwu Hospital in recent 3 years. Results Clinical feature of syphilitic vasculitis in the central nervous system includes： ①Subacute or chronic onset, progressively developed, performing a variety of clinical symptoms related with lesions region. ②Cerebrospinal fluid （CSF） examination： a mild lymphocytic pleocytosis and elevated protein, sugar and chloride were generally normal. ③The examinations of serum and CSF rapid plasma regain test （RPR） and Treponema pallidum particle agglutination （TPPA） were indispensable proof for diagnosis. ④Neuroimaging demonstrated variety and transmigratory focus. ⑤The abnormalities seen on angiography and histopathology was helpful but completely nonspecific. Conclusions The clinical manifestations of syphilitic vasculitis in the central nervous system are diversification and the misdiagnosis rate is high. The diagnosis is based on important personal life history, clinical findings, examination of the serum and CSF and neuroimaging. Accordingly, syphilitic vasculitis should always be considered in the differential diagnosis of stroke in young adults. The serum and CSF testing for syphilis and timely and effective treatment are very important.