神经梅毒29例的回顾性临床分析

Retrospective Analysis of 29 Cases with Neurosyphilis

目的:观察总结神经梅毒的临床特点,以提高神经梅毒的诊断和治疗水平。方法:回顾性分析哈尔滨医科大学附属第一医院2005年1月至2012年12月神经内科病房收治的29例神经梅毒患者的临床资料。结果:29例神经梅毒患者中临床分型:其中,无症状型神经梅毒2例,主要表现为患者无症状,仅脑脊液呈轻度炎性反应,梅毒血清反应阳性;梅毒性脑膜炎6例,主要表现为头痛、呕吐及脑膜刺激征,偶可见意识障碍、谵妄及抽搐。血管型梅毒3例,主要表现为偏瘫、偏身感觉障碍、偏盲、失语等。脊髓痨11例,主要表现为感觉异常如束带感和蚁走感,共济失调、内脏危象及阿罗瞳孔等。麻痹性痴呆7例,临床表现为进行性痴呆合并神经损害为主。结论:神经梅毒的起病隐袭,临床表现复杂多样,神经系统各部位都可受累,容易误诊,。但青霉素治疗有效。对于疑似病例应及时行血清及脑脊液检查,可获得早期诊断,对指导治疗及预后均有重要意义。

Objective： To summerize the object is to observe summerize the clinical features of neurosyphilis, then improve the le vel of diagnosis and treatment of neurosyphilis. Methods： a A retrospective analysis was made on the clinical data of 29 patients with neurosyphilis admitted of from January 2005 January to December 2012 December in the neurological department of internal medicine 29 cases clinical data of patients with neurosyphilis of First Affiliated Hospital of Harbin Medical University. Results： Of the 29 cases of with neurosyphilis patients clinical were classified： 2 cases of asymptomatic neurosyphilis were without any symptome, only a mild inflammatory reaction in the cerebrospinal fluid, and syphilis serum reaction. 6 cases were with Syphilitic meningitis, mained with headache, vomiting and meningeal irritation, occasionally visible consciousness disorders, delirium and convulsions. The; 3 case number of meningovascular neurosyphilisvascular type of syphilis were 3, mainly forcharacteristic of hemiplegia, hemidysesthesia, hemianopia, aphasia and otherso on. 11 cases of Spinal spinal tuberculosis waswere found and 11 cases, mainly characteristic offor the sensory abnormalities such as band and formication, ataxia, visceral crisis and Arlo pupil. Paralytic dementia： a report of 7 cases, clinical manifestations of dementia associated with nerve damage mainly. Conclusion： neurosyphilis Neurosyphilis had insidious onset, and clinical manifestations are were complex. The nervous system may be involved in different parts, and easy be misdiagnosissd. But penicillin treatment was effective. For suspected cases, it should be prompt in serum and cerebrospinal fluid examination, in order to obtain early diagnosis. It is was significant for the treatment and prognosis of guidance.