以情绪躁狂为首发表现的神经梅毒20例

Neurosyphilis with mania as the first manifestation： report of 20 cases

目的 探讨以情绪躁狂为首发症状的神经梅毒的临床表现及其治疗方法.方法 回顾分析2009年7月至2010年6月以情绪躁狂为首发症状的神经梅毒患者的临床资料.结果 20例患者均被误诊为精神分裂症、焦虑症、脑梗死等,均以易怒、脾气暴躁、行为冲动、思维紊乱等情绪躁狂为起病时的主要症状,部分患者同时伴有记忆力、认知能力、计算能力等的明显下降.所有患者血清快速血浆反应素环状卡片试验（RPR）及梅毒螺旋体血球凝集试验（TPHA）均阳性,脑脊液性病实验室检查试验（VDRL）阳性.经驱梅及与抗精神病药物联合治疗后,症状有不同程度改善.随访治疗后满3个月的13例患者并进行脑脊液检查,10例脑脊液VDRL滴度下降,1例VDRL转阴性,2例较治疗前无改变.结论 神经梅毒临床缺乏特征性.当常规抗精神病治疗疗效不佳时,应考虑神经梅毒可能,并进行梅毒血清学及脑脊液检查.

Objective To assess the clinical presentations and treatment of neurosyphilis with mania as the first manifestation. Methods A retrospective study was performed. Clinical data on neurosyphilis patients with mania as the first manifestation collected from July 2009 to June 2010 were analyzed. Results Twenty cases of neurosyphilis were included in this study, which were all misdiagnosed as schizophrenia, anxiety,cerebral infarction, etc. All the patients had manic symptoms at onset, such as irritability, bad temper, impulsive behavior, disturbance in thinking, and so on. Some patients also suffered from a marked decrease in memory, calculation and cognitive ability. Rapid plasma reagin （RPR） test, Treponema pallidum hemagglutination （TPHA）test and cerebrospinal fluid （CSF） venereal disease research laboratory （VDRL） test were positive in all the patients. Varying degrees of symptomatic improvement was achieved after anti-syphilis and anti-psychotic treatment. CSF was retested in 13 patients 3 months after the end of treatment, and CSF VDRL titer decreased in 10 patients, remained unchanged in 2 patients, and turned negative in 1 patient. Conclusions Neurosyphilis lacks distinctive clinical characteristics. For patients with poor response to conventional antipsychotic therapy,neurosyphilis should be considered, and serology and cerebrospinal fluid tests for syphilis are warranted.