麻痹性痴呆临床分析

Clinical Analysis of Paralytic Dementia

目的分析麻痹性痴呆的临床表现、实验室和脑电图检查结果、影像学特征及预后。方法回顾性分析12例麻痹性痴呆患者的临床资料。结果 12例麻痹性痴呆以痴呆为突出表现,且均有认知障碍。7例出现精神障碍(占58%)、3例样发作(占25%)、2例偏瘫(占17%)、4例出现阿-罗瞳孔(占33%)。血清及脑脊液梅毒螺旋体ELISA试验均阳性,脑脊液压力、白细胞数、蛋白含量正常或轻度增高,糖与氯化物均正常。脑电图6例提示中高波幅慢波。影像学(CT或MRI)显示:脑萎缩8例,占66.7%,额颞叶萎缩明显。12例患者经驱梅治疗后,10例明显好转,TRUST试验滴度显著下降(占83%),2例疗效不佳。结论麻痹性痴呆临床表现多样化,误诊率高。流行病学资料、病史、临床表现、脑电图及影像学检查可为诊断提供重要依据,依据血清和脑脊液梅毒抗体检测可确诊,并根据TRUST试验判断疗效。足量的青霉素治疗疗效较好。

Objective Analyze the clinical manifestations,results of laboratory and EEG examinations,imaging features and prognoses of paralytic dementia. Method Retrospectively analyze the clinical data of 12 cases of paralytic dementia patients. Results Dementia is the typical clinical manifestation of the 12 cases of paralytic dementia and all of the patients examined suffer cognition disability. Among them, 7 patients （58%） suffer from psychonosema; 3 （25%） suffer from seizure activities,2（17%）suffer from hemiplegia and 4 （33%） suffer from Argyll Robertson pupil. Syphilis ELISA tests for blood and cerebrospinal fluid show positive. Cerebrospinal fluid receives normal pressures. White cell count and protein content is normal or slightly increased. The contents of sugar and chloride are mostly normal. Most EEG tests suggest medium or high amplitude slow waves （6 cases）. CT/MRI shows that there are 8 cases （66.7%） of brain atrophy along with obvious frontal-temporal lobe atrophy among them. After antisyphilitic treatment, 10 cases in 12 apparently get better-off. Experiment TRUST titer is dramatically decreased,accounting for 83% and the rest 2 cases has unsatisfactory treatment effects. Conclusion Paralytic dementia has diversified clinical manifestations and high misdiagnosis rate. Epidemiologic data, medical history and clinical manifestations,EEG as well as CT examinations provide important evidence for diag- nosis. Confirmed diagnosis can be made according to blood serum tests and cerebrospinal fluid syphilis antibody tests and treatment effects can be judged from TRUST experiments. Sufficient penicillin has an accurate treatment effect.