神经梅毒12例临床特征及影像学分析

Clinical and imaging analysis of 12 patients with neurosyphilis

目的探讨神经梅毒的临床特征及影像学表现。方法回顾性分析2000年1月~2008年4月我院收治的12例神经梅毒患者的临床资料。结果12例神经梅毒患者中脑卒中样起病6例,麻痹性痴呆2例,脊髓损害2例,脑膜炎及神经炎各1例;血清梅毒甲苯胺红不加热血清反应素试验及梅毒螺旋体明胶颗粒凝集试验均呈阳性反应;部分患者脑脊液检查示蛋白质含量升高、白细胞计数升高（以单个核细胞为主）。MR检查分别表现为脑梗死灶、脑萎缩、脑皮质异常信号、脑动脉狭窄或闭塞及脊髓空洞症等。结论梅毒螺旋体对神经系统的损害比较弥散,神经梅毒的诊断应结合临床表现、实验室及神经影像学检查资料综合分析,早期诊断、早期治疗对本病预后有重要意义。

Objective To explore the clinical characteristics and neuroimage features of neurosyphilis. Methods Retrospectively analyzed the clinical data of 12 patients with neurosyphilis admitted in our hospital from January ,2000 to April,2008. Results Among the 12 patients with neurosyphilis, stroke was the main clinical manifestation in 6 cases, dementia paralytica in 2 cases, spinal damage in 2 cases, meningitis in 1 case and neuritis in 1 case respectively. Toluidine Red Unheated Serum Test （TRUST） and Treponemal Pallidum Particle Agglutination （TPPA） in serum were all positive. Cerebrospinal fluid （CSF） examination revealed protein increased, and leukocyte count （ predominantly mononucleareells） increased in some cases. CT and MRI findings revealed cerebral infarcts,encephalatrophy,abnormal signals in cortex, cerebral arteries stenosis or occlusion and syringomyelia. Conclusions The damage of treponema pallidum to the nervous system is widespread. The diagnosis of neurosyphilis depends on comprehensive analysis of clinical characteristics, laboratory and neuroimaging examinations. Early diagnosis and treatment is important to improve the prognosis.