脑血管型神经梅毒的临床及影像学特点

发布时间：2018-12-13 16:34

【摘要】：目的:探讨脑血管型神经梅毒的临床及影像学特点。方法:应用酶联免疫法检对23例脑血管型神经梅毒患者进行血清及脑脊液梅毒螺旋体凝集试验(TPHA)和快速血浆抗体试验(RPR)检测,并对其临床资料尤其是头颅影像表现进行分析。结果:本组23例患者,表现为进展性卒中者8例(34.8%),表现短暂性脑缺血发作者3例(13.0%),既往有脑梗死病史者3例(13.0%)。所有患者血清TPHA和RPR均阳性,滴度范围为1∶4~1∶128;脑脊液TPHA和RPR均阳性,滴度1∶2~1∶64,伴或不伴细胞数及蛋白升高;头颅MRI提示颅内单一或多发梗死灶,多伴有脑萎缩及脑白质脱髓鞘改变,CTA多能发现颅内血管狭窄;所有患者进行驱梅治疗大多获得良好效果。结论:脑血管型神经梅毒进展率及复发率较高;头颅影像可发现多处病灶,血管影像可发现大中动脉为主的多处血管狭窄,且脑萎缩概率较高;驱梅治疗效果较好;缺血性脑卒中患者尤其无相关动脉硬化性及心源性等卒中危险因素时应常规进行血清梅毒检测。
[Abstract]:Objective: to investigate the clinical and imaging features of cerebrovascular neurosyphilis. Methods: serum and cerebrospinal fluid Treponema pallidum agglutination test (TPHA) and rapid plasma antibody test (RPR) were performed in 23 patients with cerebrovascular neurosyphilis by enzyme linked immunosorbent assay (Elisa). The clinical data, especially the cephalic imaging findings, were analyzed. Results: among the 23 patients, 8 (34.8%) had progressive stroke, 3 (13.0%) had transient ischemic attack and 3 (13.0%) had a history of cerebral infarction. Serum TPHA and RPR were positive in all the patients with the titer range of 1: 4: 128, TPHA and RPR in cerebrospinal fluid were positive, the titer was 1: 2 or 1: 64, with or without the increase of cell number and protein. Cranial MRI suggested that intracranial single or multiple infarct lesions were associated with cerebral atrophy and white matter demyelination, and intracranial vascular stenosis could be found by CTA. Conclusion: the rate of progression and recurrence of neurosyphilis of cerebrovascular type is high, multiple lesions can be found on cranial image, and multiple stenosis of large and middle artery can be found in vascular image, and the probability of cerebral atrophy is higher. Syphilis should be detected routinely in patients with ischemic stroke, especially when there are no related risk factors such as arteriosclerosis and cardiogenic stroke.
【作者单位】：浙江省湖州市中心医院神经内科;
【分类号】：R759.13

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