脊髓空洞型梅毒诊治探讨

A Case of Syphilitic Syringomyelia

目的 详细报告1例脊髓空洞型神经梅毒的诊疗经过。方法 患者为31岁男性,4年多前有多次非婚性交史和曾有性病史。入院前1个月开始有典型的脊髓受损的临床表现。入院时体检可见肩、背部有部分肌肉轻度萎缩,双下肢肌力降低,右侧胸2平面、左侧胸3平面以下皮肤深浅感觉减退等。血清甲苯胺红不需加热血清试验（TRUST）2次均阳性,梅毒螺旋体血凝试验（TPHA）为1:1280阳性。脑脊液检查（CSF）蛋白质定量测定为15.6g/L,TRUST检查呈阳性,白细胞126 × 10～6/L,其中淋巴细胞占0.67％、中性粒细胞0.33％。磁共振成像（MRI）发现“延髓下段至胸10大范围空洞,中央管扩大,呈长T1、长T2信号,脊髓实质菲薄,脊髓外形增粗,注射钆喷酸葡胺（Gd-DTPA）后见下颈段及胸段脊髓呈环状、不规则强化”。用水剂青霉素G注射液静脉点滴2400万单位/天,共15d。结果 患者病情迅速好转,生活可自理。3个月后血TRUST转阴性。半年后CSF复查有关项目全部恢复正常,TRUST转为阴性。随访2年,疗效稳定,病情无反复。结论 此为国内首例脊髓空洞型梅毒报告。

Objective To report in detail a case of syphilitic syringomyelia, which is an extremely uncommon variant of neurosyphilis. Methods Comprehensive analysis and estimate were made according to the clinical manifestations, blood chemistries including syphilitic serum tests, checks of cerebrospinal fluid(CSF)and typical images of MRI. Results There were histories of illegally sexual contacts and many times infection with sexually transmitted diseases four years ago. The patient had corresponding symptoms and signs of spinal cord damaged at the admission to our hospital. Blood chemistries showed TRUST and TPHA test positive.The changes including TRUST in CSF supported the diagnosis of neurosyphilis.The MRI image revealed an enormous hole from lower medulla oblongata to 10th thoracispinal part, and the enlargement of central canal in existence. Conclusion This is the first case of syphilitic syringomyelia reported in China.