以精神症状首发的麻痹性痴呆患者20例临床分析

Clinical analysis of the onset of mental symptoms in patients with paralytic dementia

目的总结以精神症状为首发症状的麻痹性痴呆患者的临床特点。方法收集20例以精神症状起病的麻痹性痴呆患者的临床资料,其中男15例,女5例,年龄42~66岁。所有患者均经血清和脑脊液梅毒螺旋体特异性抗体测定(TPPA)、梅毒荧光抗体吸附试验(FTA-ABS)及梅毒甲苯胺红不加热血清试验(TRUST),并结合临床症状确诊。总结其临床表现、实验室检查、神经电生理及影像学检查的特点。结果入组20例病人均符合神经梅毒诊断标准,均为慢性起病,首发症状为精神心理及行为异常,血清和脑脊液梅毒螺旋体特异性抗体、梅毒荧光抗体吸附试验Ig G和梅毒甲苯胺红不加热血清试验阳性,脑电图无特异性表现,头颅磁共振结果多样,其中正常8例,脑室强化信号1例,树胶样肿3例,脑萎缩8例。结论麻痹性痴呆患者首发症状不典型,常被误诊。对以精神症状首发的患者,应常规行血清梅毒及头颅影像学检查,对于头颅磁共振显示与其年龄不符合的脑萎缩,应加强对病史的询问,警惕神经梅毒,麻痹性痴呆可能。

Objective To analysis the clinical characteristics of paralytic dementia patients who have psychiatric symp- toms as the first symptom. Methods The clinical data of 20 patients with paralytic dementia were retrospectively ana- lyzed. The patients ranges at the age from 42 to 66 years old and include 15 male and 5 female. All patients were diag- nosed based on syphilis serum specific antibody （TPPA）, syphilis fluorescent antibody adsorption test （FTA - ABS）, syphilis toluidine red unheated serum test （TRUST） and clinical symptoms. Characteristics of the clinical manifesta- tion, laboratory examination, eleetrophysiology and imaging examination were summarized. Results All 20 patients had chronic onset with mental and behavior disorders as the first symptoms. Syphilis specific antibody, syphilis IgG fluores- cent antibody assay and syphilis toluidine red unheated serum test were positive in the serum and cerebrospinal fluid. EEG and cranial MRI were not specific. In cranial MRI, 8 cases had normal result, 1 case had enhanced ventricular signals, 3 cases had gum swelling, and 8 cases had cerebral atrophy. Conclusions Paralytic dementia with psychiatric symptoms are often misdiagnosed. The patients with psychiatric symptoms should complete syphilis serum and cranial MRI examination. And patients with brain atrophy in MRA should he inquired about the history and paid attention to neurosyphilis.