神经梅毒临床特征分析

The analysis on clinical characteristics of neurosyphilis

目的分析神经梅毒的临床、神经影像学和实验室检查特征。方法回顾性分析符合神经梅毒诊断标准的3例患者的临床、神经影像和实验室资料。结果3例患者均为男性,梅毒性血管炎、麻痹性痴呆、梅毒性脑膜炎伴视神经炎各1例;血清和脑脊液快速血浆反应素(rapidplasmareagin,PRP)试验及梅毒螺旋体血凝试验(treponemapalliadumhemagglutinationassay,TPHA)均阳性;MRI显示左延髓、左小脑半球、基底节多发长T1长T2斑点状异常信号。TCD、颈动脉超声和DSA提示多发血管炎。结论神经梅毒根据不同类型有不同发病形式,首诊易误诊,神经影像学可提示颅内多发血管病变,血清和脑脊液梅毒抗体阳性即可确诊,青霉素为首选药物。

Objective To study the clinical feature, neuroimages and laboratory findings of neurosyphilis.Method Clinical features,neuroimages and laboratory findings from 3 neurosyphilis patients were analyzed retrospectively.Results Three patients are all males.They were originally diagnosed.Syphilitic cerebral arteritis for 1 case,general paresis 1 case,and meningitis syphilis companied with optic neuritis 1 case.In all cases,the rapid plasma reagin (RPR) and treponema pallidum hemagglutination assay (TPHA) test of both serum and CSF samples showed positive;MRI demonstrated multiple areas with lower-intensity T_1 and high-intensity T_2 in basal ganglion,left medulla and cerebellum.Carotid ultrasound,TCD and DSA suggested multiple arteritis.Conclusion Patients with neurosyphilis could present diverse clinical symptoms at beginning of the course and be divided to different clinical types accordingly,therefore it is misdiagnosed easily at first visit.However,neuroimaging could provide evidence of multiple arteritis.More importantly positive syphilis antibody in serum or CSF is specific for diagnosis.Penicilin is the first choice for effective treatment.