神经梅毒临床特点分析

发布时间：2018-05-19 09:26

  本文选题：神经梅毒 + 脑血管意外　； 参考：《福建医科大学》2011年硕士论文

【摘要】：目的:探讨神经梅毒的临床特点,分析漏诊、误诊原因,提高诊断率,改善预后。 方法:回顾性分析我院从2007年3月至2011年3月确诊的53例和疑似的13例神经梅毒临床资料。 结果:①本组中无症状神经梅毒5.66%;脑脊膜梅毒11.32%;脑膜血管梅毒49.06%;实质型神经梅毒33.96%,其中麻痹性痴呆28.30%;未发现树胶肿性神经梅毒病例。②临床上首发临床症状多样,表现为:局灶性神经功能缺损症状(如肢体无力、感觉障碍、构音障碍、失语等卒中样表现)33.9%、眩晕28.3%、认知功能减退26.4%、头痛15.1%等,而瞳孔异常(阿罗-瞳孔)仅为3.8%。③CSF的异常中白细胞增加者50.9%;CSF蛋白升高者60.4%,以淋巴细胞为主;白细胞和蛋白同时升高者31.4%;IgG指数升高者66.0%。④影像学表现各异,卒中样影像学表现43.4%(缺血性卒中样表现41.5 %,以多发、大小不一的梗死灶为主,出血性卒中1.9%)、脑炎或脑膜炎11.3%、脑积水3.8%、白质脱髓鞘性病变3.8%、脑萎缩22.6%。⑤神经梅毒组及疑似神经梅毒组EEG异常率分别为80.4%和76.9%,明显高于对照组(P0.05),以背景活动增多及弥漫性慢波异常为主。VEP中神经梅毒组与疑似神经梅毒组P100潜伏期分别为(100.80±13.13 )ms和(99.38±11.10)ms,其与对照组相比,P100潜伏期均显著延长(P 0.05)。BAEP、SEP表现为V波潜伏期( PL)、Ⅲ-V波峰间差值( IPL)及N20波潜伏期( PL)延长,与对照组比较,差异有显著性( P 0. 05)。 结论:①本组研究中,首发临床表现以局灶性神经功能缺损症状多见,其次为眩晕、认知功能减退及头痛等。与高血压或动脉硬化性脑梗塞、病毒性脑炎等有一定相似性。因此临床上遇到无危险因素的青年人卒中、不明原因的颅内感染、痴呆等情况,需警惕神经梅毒可能。②脑脊液常规、生化检查及影像学表现不具特异性。③EEG、VEP、BAEP、SEP等神经电生理检查有利于神经功能障碍的评估,为临床定位或临床下损害提供客观依据,同时也有提示诊断作用。
[Abstract]:Objective: to explore the clinical features of neurosyphilis, analyze the causes of missed diagnosis, misdiagnosis, improve the diagnosis rate and improve the prognosis. Methods: the clinical data of 53 cases of neurosyphilis and 13 cases of suspected neurosyphilis from March 2007 to March 2011 were analyzed retrospectively. Results in this group, asymptomatic neurosyphilis 5.66; meningeal syphilis 11.32; meningeal vascular syphilis 49.06; parenchymal neurosyphilis 33.96; palsy dementia 28.30; no gumulus neurosyphilis was found. The symptoms of focal neurological impairment (such as limb weakness, sensory disturbance, dysarthria, aphasia, etc.) were as follows: stroke symptoms (33.9%), dizziness (28.3%), cognitive impairment (26.4%), headache (15.1%), and so on. In the abnormal pupil (aro-pupillary), the leukocyte increased in 50.9% and the CSF protein was increased in 60.4%, mainly in lymphocytes, while in the cases with increased WBC and protein at the same time, 66.0.4 had different imaging manifestations. Stroke-like imaging findings were 43.4% (41.5% of ischemic apoplexy), with multiple infarcts of various sizes. The abnormal rates of EEG in cerebral atrophy 22.6.5 neurosyphilis group and suspected neurosyphilis group were 80.4% and 76.9%, respectively, which were significantly higher than those in control group (P 0.05). The latency of P100 in neurosyphilis group and suspected neurosyphilis group was 100.80 卤13.13 Ms and 99.38 卤11.10 msrespectively in diffuse slow-wave abnormality. Compared with control group, P100 latency was significantly prolonged as V wave latency (PLP, 鈪，

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