摘要
目的探讨以精神症状为首发的神经梅毒的临床及头颅磁共振成像(MRI)表现。方法对2010年1月至2013年6月以精神症状为首发症状的8例神经梅毒患者进行回顾性分析。结果 8例患者均被误诊为双向情感障碍、焦虑症、脑炎等,部分患者同时伴有反应迟钝、认知能力明显下降。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。8例MRI均有异常表现,脑部多发的缺血灶5例,其中表现为脑炎样改变2例;混合型2例,表现为额、颞叶萎缩;局部脑膜增厚1例。结论神经梅毒临床和MRI表现缺乏特征性,临床易误诊,当常规治疗效果不佳时,应进行梅毒血清学检查,考虑神经梅毒可能。
Objective To investigate the clinical manifestations and the images of magnetic resonance imaging (MRI)of neurosyphilis (NS)with psychopaths as the first symptom.Methods Eight cases with psychopaths as the first manifestation were enrolled from January 2010 to June 2013,clinical data and MRI images on neurosyphilis were collected.Results Eight cases were misdiagnosed as bipolar disorder,anxiety or cerebral infarction and so on.Several patients also suffered from marked decrease in memory,calculation and cognitive ability.Rapid plasma regain(RPR) test and treponema palladium hemagglutination (TPHA)test were positive in all patients.All eight patients had abnormal MRI findings.Among the cases,the MRI findings showed multiple cerebral ischemia and infarction lesions in five patients.Two cases showed similarity to those in encephalitis,MRI findings presented as frontal and temporal atrophy in two patients,and one patient showed local meningeal thickening.Conclusion Because of the clinic manifestations and MRI findings of neurosyphilis were lack of specificity,it was liable to be diagnosed erroneously.For the patients with poor response to conventional antipsychotic therapy,neurosyphilis should be considered,and serology tests for syphilis were warranted.
出处
《临床荟萃》
CAS
2015年第9期984-987,共4页
Clinical Focus
关键词
神经梅毒
梅毒血清诊断
磁共振成像
neurosyphilis
syphilis serodiagnosis
magnetic resonance imaging