脑膜血管型神经梅毒的MRI表现分析

MRI manifestations of meningovascular neurosyphilis

目的分析脑膜血管型神经梅毒的MRI影像特征,通过结合临床表现及实验室检查,以达到早期诊断的目的。方法回顾性分析经临床及实验室确诊的脑膜血管型神经梅毒患者9例,HIV均为阴性。采用3.0T MRI进行成像扫描,其中头颅MRI平扫+MRA8例,常规头颅MRI平扫1例,对上述临床及影像学资料进行分析总结。结果 9例患者以男性居多(7/9),临床以急性或亚急性起病,患者首发症状多表现为四肢乏力、头晕、言语不利及认知障碍等上述症状的不同组合。脑膜血管型神经梅毒的基本MRI表现包括:①脑萎缩,可为对称或非对称性脑萎缩;②脑梗塞,表现为多部位、多发梗塞灶,且病灶范围、新旧不一;③脑血管狭窄,呈多发节段性狭窄,常为双侧不对称性,近段血管病变更易累及。结论 MRA可评估脑血管受累情况,对无脑卒中高危因素的青中年患者,发现脑萎缩基本改变,伴颅内多发、散在的梗塞灶,需尽早行血清及脑脊液梅毒抗体检查,争取早期诊断、治疗,以改善预后。

Objective To analyze MRI manifestations of meningovascular neurosyphilis,so as to improve its early diagnosis by combination of clinical examinations and laboratory tests.Methods MRI data of 9 patients with meningovascular neurosyphilis were enrolled,with all patients were negative in HIV test.Except for 1 patient who underwent MRI head plain scan,the others were all examined by MRA.Results 7/9 patients were male.The disease started in an acute or subacute way and the main clinical manifestations were paresis,headache,lalopathy,cognitive disorder or any combination of them.The MRI manifestations of meningovascular neurosyphilis included:(1)cerebral atrophy,which could be symmetrical or asymmetrical.(2)cerebral infarction,which could be of multiple locations,and multiple lesions,with varied focal ranges and onset times;(3)cerebrovascular stenosis,which could be of multi-segmental stenosis with bilateral asymmetry,and the proximal part of the arteries was vulnerable to be involved.Conclusion MRA is able to evaluate the cerebral vascular involvement non-invasively.Once a young patient without high risky factors of stroke is manifested as cerebral atrophy,infarction and intracranial vascular stenosis in MRI and MRA,tests of syphilis antibody in serum and cerebrospinal fluid should be carried out as soon as possible,so as to improve the prognosis.