神经梅毒的临床特征及诊断(附3例报告)

Clinical characteristics and diagnosis of neurosyphilis a report of three cases

目的分析神经梅毒的临床特征及提供早期诊断依据。方法回顾性分析经临床和实验室检查确诊的3例神经梅毒患者的临床资料和有关资料。结果神经梅毒的临床特征包括:①急性、亚急性起病多,少数慢性起病;②临床以间质型,尤其脑卒中最常见;③螺旋体明胶凝集(TPPA)试验及梅毒快速血浆反应素试验(RPR)阳性率极高;④脑脊液检查表现为蛋白含量增加、细胞数增多(以淋巴细胞为主);⑤头颅CT或MRI表现与高血压、糖尿病所致常见的脑梗死不同,病灶多发,可分布在脑的所有部位。结论神经梅毒的临床特征没有特异性,误诊率高,临床表现、实验室及影像学检查是其诊断的重要依据。

Objective To analyse the clinical features of neurosyphilis in order to help early diagnosis. Methods A retrospective analysis in 3 cases of neurosyphilis diagnosed by clinical and laboratoPy examinations was focused on their clinical manifestations. Resealts The clinical features of neurosyphilis： （1）Acute or subacute onset was common, while chronic onset was minority;（2）Interstitial neurosyphilis, especially cerebral infarction was the common sort in the clinical;（3）TPPA test and RPR test were of the highest specificity among the seMogic tests;（4）CSF examination revealed that CSF protein content was increased significantly, and cells count, mainly lymphocytes increased;（5）Cranial CT/MRI findings revealed multiplex, asymmetrical lesions, which were different from those of cerebral infarctions caused by hypertension or diabetes. Conclusion Neurosyphilis has a high misdiagnosis rate, and its diagnosis depends on clinical manifestations, laboratory and imaging examinations.