表现为脑梗死的41例神经梅毒的临床表现和治疗分析

Analysis of 41 cases of neurosyphilis presenting with cerebral infarction

目的观察表现为脑梗死的神经梅毒临床特点，探讨其治疗及预后。方法分析41例此类患者的临床表现、心理量表评分、实验室检查和影像学等资料。结果41例中有智能下降23例；表现肢体瘫痪30例，肢体麻痹8例，眩晕2例，癫痫样发作1例；头颅MRI显示脑萎缩及多发梗死灶，脑水肿占位表现不显著；血液及脑脊液梅毒螺旋体血凝试验（TPHA）阳性；用大剂量青霉素治疗后，95．1％临床症状得到改善。结论神经梅毒临床表现多样，易误诊；MR显示多发脑梗死、脑萎缩、占位效应不明显；青霉素治疗有效，且疗效较好，但合并大面积脑梗死预后较差。

Objective To investigate the clinical characteristics of neurosyphilis presenting clinically with cerebral infarction and study its treatment and prognosis. Methods A retrospective analysis was conducted in 41 patients with neurosyphilis who presented clinically with cerebral infarction. The clinical manifestations, neurological deficit scores, activity of daily life （ADL） scores, mental scale scores, and laboratory and imaging examination results of the patients were analyzed. Results Of the 41 patients, 23 exhibited reduced intelligence, 30 had limb paralysis, 8 had limb numbness, 2 complained of dizziness, and 1 experienced epileptic attacks. Head magnetic resonance imaging （MRI） revealed the presence of brain atrophy and multiple infarction loci without obvious space-occupying effect of cerebral edema in these patients. All the patients showed positive results of serum and cerebrospinal fluid Treponema pallidum hemagglutination assay （TPHA）. After treatment with high-dose penicillin, 95.1% of the patients had improvements of the clinical symptoms. Conclusion The diverse clinical manifestations of neurosyphilis often result in misdiagnosis of the disease. Patients with neurosyphilis show multiple cerebral infarction loci and cerebral atrophy without obvious space-occupying effect on MRI. Penicillin can be an effective treatment in such cases, which generally have low rate of negative TPHA within 3 months. Such patients have more favorable clinical outcomes than those with common cerebral infarction, but poor prognosis is indicated in cases with concurrent extensive cerebral infarction.