合并周围神经损害神经梅毒患者的临床与神经电生理

Clinical and electrophysiological characteristics of neurosyphilis patients combined with peripheral nerve damage

目的 探讨合并周围神经损害的神经梅毒患者的临床表现与神经电生理特点。方法 选取2018年4月至2021年11月福建省立医院南院神经内科收治的5例合并周围神经损害的神经梅毒患者,分析其临床表现、实验室检查及神经电生理特点。结果 5例患者中1例表现为急性多发性神经根神经炎,肌电图符合吉兰-巴雷综合征电生理诊断标准。4例为脊髓痨,缓慢起病,主要表现为双下肢麻木、疼痛,伴行走不稳及小便障碍等。体征主要有四肢腱反射减弱,双下肢音叉振动觉减退,Romberg征阳性;1例双下肢肌力减退,1例双下肢病理征阳性,1例有阿-罗瞳孔。1例肌电图呈广泛神经源性损害,另4例肌电图呈运动纤维均受累,轴索、髓鞘均受损。结论 神经梅毒患者的临床表现复杂多样,可合并周围神经损害,表现为急性多发性神经根神经炎,也可呈广泛神经源性损害。

Objective To investigate clinical and electrophysiological characteristics of neurosyphilis patients combined with peripheral nerve damage. Methods From April 2018 to November 2021, 5 neurosyphilis patients combined with peripheral nerve damage in the Department of Neurology of Fujian Provincial Hospital South Branch were selected to analyze their clinical manifestations, laboratory examinations and electrophysiological characteristics. Results One patient exhibited acute polyradiculoneuritis, and the electromyography(EMG) was in line with the electrophysiological diagnostic criteria of Guillain-Barre syndrome. Four patients were diagnosed as tabes dorsalis, characterized by slow onset, numbness and pain in both lower limbs, gait disturbance and dysuria. They had weakened tendon reflex of limbs, decreased vibration sensation of both lower limbs measured by tuning fork and positive Romberg sign. One patient had decreased myodynamia of both lower limb muscles, one patient with positive pathological signs of both lower limbs and one patients with Argyll-Robertson pupil. EMG showed one patient with extensive neurogenic damage, four patients with motor fibers which were involved, and damaged axons and myelin sheath. Conclusion Clinical manifestations of neurosyphilis patients are complex and diverse. These patients may be complicated with peripheral nerve damage, exhibiting acute polyradiculoneuritis or extensive neurogenic damage.