神经梅毒17例临床分析

Clincal Analysis of 17Case Neurosyphilis

目的分析神经梅毒的临床特征和早期诊断依据。方法回顾性分析我院17例神经梅毒的临床特征、血清、脑脊液改变及影像学表现。结果本组无症状神经梅毒5例,梅毒性脑膜炎1例,脑膜血管梅毒2例,耳神经梅毒1例,麻痹性痴呆6例,脊髓痨1例,视神经萎缩1例。17例血清TRUST及TPPA均为阳性,CSF-VDRL阳性者12例。7例在治疗后1～6月复查脑脊液的各项指标,白细胞计数和蛋白含量均下降或转阴,而CSF-VDRL试验仅1例转阴。结论未能早期发现和治疗梅毒是导致神经梅毒的重要因素。神经梅毒的临床表现多种多样,容易误诊,梅毒血清及脑脊液检查是诊断的必要依据。脑脊液白细胞计数与蛋白含量是监测神经梅毒疗效的较敏感指标,应争取早期诊断、早期治疗以改善预后。

Objective To analyze the clinical features of neurosyphilis and early diagnosis. Methods Retrospective analysis of 17 cases the clinical characteristics of neurosyphilis, serum, cerebrospinal fluid changes and imaging features in our hospital. Results There are five cases of asymptomatic neurosyphilis, one case of syphilitic meningitis, two cases of syphilis meningovascular, one case of ears neurosyphilis, six cases of paralytic dementia, one case of spinal tubereulosis and one case of optic atrophy. All the seventeen cases of serum TRUST and TPPA were positive; Twelve cases of CSF- VDRL positive, after one to six months treatment, there are seven cases recheck the index of cerebrospinal fluid, white blood cell count and protein content decreased or negative, and only one case CSF-VDRL test negative. Conclusion The failure of early detection and treatment of syphilis is an important factor in neurosyphilis. Clinical manifestations of neurosyphilis is variety ,and easily misdiagnosed, syphilis in serum and cerebrospinal fluid examination is the necessary basis for diagnosis. Cerebrespinal fluid white blood cell count and protein content of neurosyphilis is sensitive indicators to monitor the effect.Early diagnosis and treatment can improve the prognosis.