麻痹性痴呆12例分析

发布时间：2018-04-02 22:12

本文选题：麻痹性痴呆　切入点：临床特点　出处：《中国神经免疫学和神经病学杂志》2014年02期

【摘要】：目的通过分析麻痹性痴呆(general paresis of the insane,GPI)患者的临床表现、及实验室检查(包括大脑影像学、脑电图)特征,提高GPI早期诊断准确率。方法回顾性分析2003 08-2011 11收治的12例GPI患者临床表现、实验室检查(包括影像学及脑电图)结果、诊断及治疗转归。结果本组12例GPI(男10例、女2例)中,表现为认知损害12例,腱反射亢进10例;血清快速血浆反应素试验(serum rapid plasma reaction test,RPR)阳性11例,梅毒螺旋明胶体被动颗粒凝集试验(serum treponema palladium particle agglutination,TPPA)阳性7例,荧光密螺旋抗体吸收试验(fluorescent treponemal antibody absorption,FTA ABS)阳性4例;脑脊液白细胞计数增高6例,蛋白质增高9例,其中5例为脑脊液白细胞及蛋白质同时增高;8例行脑脊液RPR均为阳性,12例行梅毒螺旋体血凝试验测定(treponema pallidum hemagglutination assay,TPHA)均为阳性;头部CT、MRI改变以颞叶海马部脑萎缩、脑梗死为主;脑电图以轻度异常改变为主。误诊8例。所有患者经青霉素驱梅治疗后临床症状都有不同程度好转,3例患者复查血清RPR滴度下降。结论 GPI临床表现复杂多变,误诊率高,应结合实验室及影像学检查综合分析,早期诊断及治疗极为重要。
[Abstract]:Objective to improve the accuracy of early diagnosis of paresis by analyzing the clinical manifestations and laboratory features (including brain imaging and electroencephalogram) of patients with paralytic dementia.Methods the clinical manifestations, laboratory findings (including imaging and electroencephalogram), diagnosis and treatment of 12 patients with GPI were retrospectively analyzed.Results 12 cases of GPI (male 10 cases, female 2 cases) showed cognitive impairment, 10 cases of tendon hyperreflexia, and 11 cases of serum rapid plasma reaction test positive.The serum treponema palladium particle agglutination test was positive in 7 cases, fluorescent dense treponemal antibody absorption test in 4 cases, leukocyte count in cerebrospinal fluid increased in 6 cases, protein in 9 cases.Among them, 5 cases were cerebrospinal fluid leucocyte and protein increase simultaneously. 8 cases were RPR positive in cerebrospinal fluid, 12 cases were positive for Treponema pallidum hemagglutination assayus, and the change of head CT MRI was mainly cerebral atrophy of temporal lobe hippocampus and cerebral infarction.The electroencephalogram (EEG) was mainly slightly abnormal.8 cases were misdiagnosed.The clinical symptoms of all patients were improved in varying degrees after penicillin treatment. The serum RPR titer decreased in 3 patients.Conclusion the clinical manifestations of GPI are complicated and changeable, and the misdiagnosis rate is high. It is very important to make early diagnosis and treatment in combination with laboratory and imaging examination.
【作者单位】：广西医科大学第一附属医院神经内科;
【基金】：国家自然科学基金资助项目(81160152;81371333) 广西自然科学基金资助项目(2013GXNSFCA019013)
【分类号】：R749.16

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