以头痛为首发表现的颅内树胶肿型神经梅毒

Intracranial syphilitic gumma with headache as first symptom:a case report

报告1例以头痛为首发表现的颅内树胶肿型神经梅毒。患者男,39岁。表现为头痛伴有反应迟钝、记忆力减退等症状。快速血浆反应素环状卡片试验(RPR)阳性,滴度1:128、梅毒螺旋体颗粒凝集试验(TPPA)阳性,滴度>1:1 280;脑脊液检查:性病研究实验室试验(VDRL)(+)、RPR 1:2,荧光梅毒螺旋体抗体吸收试验(FTA—ABS)::IgG(+)、IgM(-)。头颅磁共振成像(MRI):颅内梅毒树胶肿。经青霉素治疗后,临床症状明显改善。该病的影像学表现缺乏特征性,诊断需综合分析临床表现、实验室检查及影像学资料。

A case of intracranial syphilitic gumma with headache as first symptom is reported. A 39-year-old male presented with headache, unresponsiveness, memory loss, etc. Blood examination showed RPR（l：125） and TPPA（〉1：1 280） positive. Cere- brospinal fluid examination revealed VDRL positive and RPR（1：2）. FTA-ABS showed IgG（＋） and IgM（-）. The diagnosis of intracranial syphilitic gumma was made by brain MRI. The clinical manifestations were alleviated by treatment with penicillin. The imaging changes of intracranial syphilitic gumma are nonspecifie. It is necessary to integrate the clinical manifestions, laboratory examination and imaging findings to diagnose this disease.