神经梅毒的临床、影像及病理特点分析

发布时间：2018-11-27 10:55

【摘要】：目的探讨梅毒螺旋体感染后神经系统损害的临床、影像及病理改变特点。方法收集海军总医院2007-2012年确诊的神经梅毒患者5例,对其临床、影像及病理改变特点进行回顾性分析。结果 5例患者均为男性,发病年龄38~65岁,病程约10个月~22年;其中麻痹性痴呆3例、脊髓痨并视神经损害1例、脑膜血管梅毒1例。首发症状分别表现为步态不稳、头痛、性格改变、言语欠流利及头晕;之后主要症状表现为记忆力减退(4例)、性格改变(3例)、言语不利(2例)、头晕伴行走不稳(2例)、双眼视力及听力减退(1例)。所有患者血清梅毒抗体均阳性,脑脊液梅毒抗体阳性4例;头颅MRI表现为脑萎缩2例,额、颞、顶叶多发异常信号2例,视神经变细1例,正常1例;行脑活检1例,示脑活检组织海绵状变性伴胶质细胞增生,组织细胞反应及血管周围淋巴细胞浸润,部分区域可见髓鞘脱失。结论神经梅毒可累及脑、脊髓和脑神经,临床特点与累及神经系统部位相关,影像学表现缺乏特异性。神经梅毒确诊需结合临床、血和脑脊液梅毒螺旋体检查及影像结果 ,必要时行脑组织活检。
[Abstract]:Objective to investigate the clinical, imaging and pathological features of nervous system damage after Treponema pallidum infection. Methods five patients with neurosyphilis diagnosed in Naval General Hospital from 2007 to 2012 were analyzed retrospectively. Results all the 5 cases were male, the onset age was 38 ~ 65 years old, the course of disease was about 10 months ~ 22 years, including 3 cases of paralytic dementia, 1 case of tuberculosis with optic nerve damage, 1 case of meningeal vascular syphilis. The first symptoms were gait instability, headache, personality change, poor speech fluency and dizziness. The main symptoms were memory loss (4 cases), personality change (3 cases), unfavorable speech (2 cases), dizziness with walking instability (2 cases), binocular vision and hearing loss (1 case). All the patients were positive for syphilis, 4 were positive for cerebrospinal fluid syphilis, 2 were cerebral atrophy, 2 were frontal, temporal and parietal multiple abnormal signals, 1 was optic nerve thinning, and 1 was normal. Brain biopsy was performed in 1 case, showing spongiform degeneration with glial cell proliferation, histocyte reaction and perivascular lymphocytic infiltration, myelin demyelination in some areas. Conclusion Neurosyphilis can involve the brain, spinal cord and cerebral nerve. The clinical features are related to the location of the nervous system, but the imaging features are not specific. The diagnosis of neurosyphilis should be combined with clinical examination, blood and cerebrospinal fluid Treponema pallidum examination and imaging results.
【作者单位】：北京海军总医院神经内科;
【分类号】：R759.13

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