梅毒性脊膜脊髓炎一例

目的探讨梅毒性脊膜脊髓炎的临床和影像学特点。方法报道1例梅毒性脊膜脊髓炎患者,并对其临床和影像学特征分析。结果患者青年女性,慢性起病,表现为双下肢麻木半年,加重伴右下肢无力2个月。既往2年前有会阴部丘疹病史。神经系统检查示右下肢肌力5-级,右下肢腱反射活跃,右侧巴宾斯基征(+);T7以下针刺觉减退,双侧关节位置觉正常,双髋以下音叉振动觉稍减退;双侧指鼻稳准,双侧跟膝胫试验欠稳准,闭目难立征(+)。血清快速梅毒反应素试验(RPR)(+);脑脊液(CSF)RPR(-);血清梅毒螺旋体血凝试验(TPHA)(+),CSF TPHA(+)。首次胸段磁共振(MRI),(神经科症状出现4个月后)提示T6~7处短T2等T1异常信号,T1强化显著,表现为炎性肉芽肿特征性的烛泪征和翻转征,后经甲强龙和青霉素治疗病灶缩小、症状痊愈。结合其既往病史、脊髓病的临床和影像表现,血和CSF梅毒抗体和相关抗体检测结果,可以确诊为梅毒性脊膜脊髓炎。结论梅毒性脊膜脊髓炎在梅毒早期或晚期均可出现,起病形式可以是急性、亚急性或者慢性,影像学多表现为局部脊髓炎症和炎性肉芽肿,经过正规驱梅治疗病灶和症状均可消失,预后良好。

Clinical and imaging features of syphilic meningomyelitis

Objective To explore the clinical and imaging features of syphilic meningomyelitis. Method An rare case of a 29-year-old female with syphilic meningomyelitis was reported. Her clinical presentation and imaging findings were discussed. The related literatures have been reviewed.Results The patient presented with numbness of bilateral lower limbs for 6 months and weakness of right lower limb for 2 months. The patient got papular lesions in the perineal region two years ago. Neurologic examination found mildly decreased strength of right lower limb, decreased pinprick sensation below T7 level, reduced vibration sensation below T12 level, positive Romberg test and right flexor plantar response. Laboratory test for the serological anti-syphilis antibody was positive, and the Treponema Pallidum Hemagglutinin Test (TPHA) in serum was positive, and the serum RPR was positive with 1:4. The TPHA in CSF was also positive, but CSF RPR was negative. Spinal MRI revealed swelling and high signal intensity of the whole thoracic spinal cord parenchyma except T6-7 level, and focal gadolinium enhancement was observed at this T2 WI-low-signal area, which were called candle guttering appearance and Flip-flop sign. She was diagnosed as syphilic meningomyelitis cased on clinical and imaging features and laboratory examinations.Conclusion Syphilic meningomyelitis can occur at early or late stage of syphilis, can be acute, subacute or chronic onset. The imaging examinations indicate focal inflammation and granuloma. Prognosis is good after proper treatment.