摘要
目的:分析23例神经梅毒的临床特征、实验室检查、影像学表现及诊治方法,提高对神经梅毒的认识。方法:收集2009年5月-2015年4月在扬州市第一人民医院神经内科住院且诊断为神经梅毒的患者23例,回顾性分析患者的临床表现、实验室检查结果及影像学特征等,探讨神经梅毒的治疗方法。结果:所有患者血清快速血浆反应素试验(RPR)和梅毒螺旋体抗原凝集试验(TPPA)检查均阳性,21例完成腰穿脑脊液检查RPR和TPPA均阳性,6例脑脊液细胞轻度增多,12例脑脊液蛋白有所增高,5例脑脊液蛋白细胞均正常。临床表现为痴呆的6例,伴有脑卒中11例,神经痛2例,癫痫发作2例,视神经炎1例,共济失调1例。头颅影像学检查无特异性,部分表现为脑梗死、脑萎缩、脑室扩大,不同程度脑白质变性、树胶样异常信号或脑回强化等。所有患者接受青霉素或头孢曲松治疗后,神经梅毒症状较前明显改善。结论:神经梅毒临床表现复杂多样,部分隐匿但危害大,联合血液学、脑脊液及影像学检查有助于临床诊断,及时合理的抗梅毒治疗可以改善预后。
Objective：To analyze the clinical features, laboratory examination,imaging characteristics and diagnosis method of neurosyphilis.Method：23 patients with neurosyphilis were selected in No.1 People＇s Hospital of Yangzhou from May 2009 to April 2015,the clinical features,laboratory examination, imaging characteristics,diagnosis and treatment of neurosyphilis were retrospectively analyzed.Result：The serum RPR and TPPA of all patients were positive,21 patients were positive with cerebrospinal fluid RPR and TPPA, 6 cases of cerebrospinal cell count increased,12 cases of the cerebrospinal fluid protein increased,the cerebrospinal fluid protein and white cell count was nomal had 5 cases.Among the 23 patients, 6 patients suffered dementia,11 cases suffered cerebral apoplexy,2 cases were neuralgia, 2 cases were epilepsy, 1 case was optic neuritis and 1 case was ataxia. The patients were no specifity MRI scanning,part of them showed cerebral infarctions,encephalatrophy,ventriculomegaly, varying degrees of cerebral white matter degeneration, gummatous abnormal signal or gyri enhancement and so on. Most of the patients showed obvious improvement in the symptoms after treated with penicillin or ceftriaxone.Conclusion： Neurosyphilis clinical manifestations are diverse and complex, part of them hidden but harm, combined with blood science, cerebrospinal fluid, and imaging examination are helpful to clinical diagnosis, timely and reasonable anti syphilis treatment can improve the prognosis.
出处
《中国医学创新》
CAS
2015年第29期136-138,共3页
Medical Innovation of China
