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中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (05) : 570 -574. doi: 10.3877/cma.j.issn.1674-1358.2016.05.012

临床论著

46例神经梅毒临床特征及影像学特点
高俊华1, 李务荣1, 伍文清1,(), 黄宇明1, 许东梅1, 张磊1   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院神经内科
  • 收稿日期:2015-08-12 出版日期:2016-10-15
  • 通信作者: 伍文清

Clinical manifestations and imaging characteristics of 46 patients with neurosyphilis

Junhua Gao1, Wurong Li1, Wenqing Wu1,(), Yuming Huang1, Dongmei Xu1, Lei Zhang1   

  1. 1. Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2015-08-12 Published:2016-10-15
  • Corresponding author: Wenqing Wu
引用本文:

高俊华, 李务荣, 伍文清, 黄宇明, 许东梅, 张磊. 46例神经梅毒临床特征及影像学特点[J]. 中华实验和临床感染病杂志(电子版), 2016, 10(05): 570-574.

Junhua Gao, Wurong Li, Wenqing Wu, Yuming Huang, Dongmei Xu, Lei Zhang. Clinical manifestations and imaging characteristics of 46 patients with neurosyphilis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(05): 570-574.

目的

探讨神经梅毒患者临床特征及影像学特点。

方法

回顾性总结2014年2月至2015年8月于首都医科大学附属北京地坛医院神经内科确诊的46例神经梅毒患者的临床特征及影像学特点。

结果

46例神经梅毒患者中男性33例,女性13例。平均年龄(50.00±10.78)岁。分为4组:无症状型神经梅毒8例(8/46,17.4%),头颅磁共振检查均未见异常。间质型神经梅毒9例(9/46,19.6%),头颅磁共振检查正常2例,急性或陈旧性梗死灶4例,颅内多发皮层异常信号2例,脑膜增强1例。脑实质型神经梅毒28例(28/46,60.9%),头颅磁共振检查正常9例,脑萎缩13例,脑积水1例,侧脑室旁缺血灶5例;2例脊髓痨患者头颅及腰椎磁共振检查均正常。梅毒性树胶肿1例(1/46,2.2%),头颅磁共振检查示右侧额叶及右侧小脑结节样强化灶,伴周围水肿。驱梅治疗后复查头颅磁共振检查正常。

结论

神经梅毒表现多样,影像学多变,临床中需将梅毒血清学化验作为常规检查以减少误诊几率。

Objective

To investigate the clinical manifestations and imaging characteristics of cases with neurosyphilis.

Methods

The clinical manifestations and imaging characteristics of the 46 cases with neurosyphilis in the Beijing Ditan Hospital, Capital Medical University from February 2014 to August 2015 were analyzed, retrospectively.

Results

Total of 46 cases were collected with the average age of (50.00±10.78) years old, among whom 33 cases were male and 13 cases were female. The cases were divided into four groups: asymptomatic neurosyphilis group with 8 cases (8/46, 17.4%), with normal results of cranial MRIs; interstitial neurosyphilis group with 9 cases (9/46, 19.6%), among whom 2 cases with normal results of cranial MRIs, 4 cases with acute/old infarctions, 2 cases with multiple abnormal signals in the cortex and one case with enhancement of the dura; parenchyma neurosyphilis group with 28 cases (28/46, 60.9%), among whom 9 cases with normal results of the cranial MRIs, 13 cases with cerebral atrophy, one case with hydrocephalus and 5 cases with ischemia in the lateral ventricle characteristics, the cranial and the lumbar spine MRIs of the 2 myelophthisis cases were normal; syphilitic gumma group with one case(1/46, 2.2%), the cranial MRI results showed enhancement nodule in the right frontal lobe and right cerebellar with edema around. After the antisyphilitic treatment, the MRI returned to normal.

Conclusion

Neurosyphilis had different performance and imaging, it was necessary to list syphilis serological examination as routine examination to reduce misdiagnosis risk.

表1 8例无症状型神经梅毒患者的临床、实验室及影像学结果
表2 9例脑膜血管型梅毒患者的临床、实验室化验及影像学结果
表3 28例脑实质梅毒患者的临床、实验室化验及影像学结果
例数 性别 年龄(岁) 症状 血清 脑脊液 影像学
TRUST TPPA TRUST TPPA 细胞数(/μl) 蛋白(mg/dl)
1 60 性格改变行为异常 1︰16 + 1︰8 + 130 102.6 头MRI正常
2 71 情绪低落听力下降 1︰32 + 1︰32 + 8 48.8 侧脑室旁缺血灶
3 61 记忆力下降行为异常 1︰64 + 1︰1 + 5 49.0 颞叶海马萎缩
4 59 精神行为异常 1︰128 + 1︰2 + 35 99.3 颞叶海马萎缩
5 63 精神行为异常 1︰64 + 1︰2 + 5 53.3 侧脑室旁点状缺血灶
6 77 记忆力、听力视力下降 1︰32 + 1︰2 + 3 71.0 颞叶、海马萎缩
7 51 记忆力下降、言语不清 1︰256 + 1︰2 + 60 191.0 颞叶海马萎缩
8 43 烦躁多语 1︰128 + 1︰8 + 70 70.6 侧脑室旁缺血灶
9 37 记忆力下降情绪异常 1︰32 + 1︰2   5 32.0 颞叶海马萎缩增强后侧脑室边缘高信号
10 48 记忆力下降行为异常 1︰256 + 1︰16 + 50 60.0 颞叶海马萎缩
11 56 幻觉行为异常 1︰64 + 1︰1 + 400 57.0 头MRI正常
12 62 性格改变记忆力下降 1︰8 + 1︰1 + 20 47.0 颞叶萎缩
13 46 记忆力下降抽搐 1︰16 + 1︰4 + 26 74.6 双侧颞叶海马萎缩左侧额叶顶叶占位性病变
14 51 性格改变记忆力下降 1︰32 + 1︰1 + 90 117.0 双侧半卵圆中心多发缺血灶
15 63 记忆力下降行为异常 1︰32 + 1︰8 + 50 52.4 脑萎缩
16 56 记忆力下降行为异常 1︰64 + 1︰32 + 5 52.0 脑萎缩白质变性
17 42 记忆力下降言语不清 1︰256 + 1︰16 + 8 87.6 脑积水头颈部CTA正常
18 66 记忆力下降 1︰2 + 1︰2 + 10 50.2 海马萎缩半卵圆中心多发梗死灶
19 53 下肢无力 1︰8 + 1︰1 + 5 50.7 头MRI、腰椎MRI正常
20 44 下肢疼痛无力 1︰32 + 1︰2 + 146 83.0 头MRI、胸椎MRI、颈椎MRI正常
21 45 下肢无力 1︰64 + 1︰4 + 71 74.0 头MRI正常C6-7异常信号
22 45 下肢麻木行走不稳 1︰32 + 1︰2 + 5 49.0 腰椎MRI正常头颅CT正常
23 56 下肢麻木无力 1︰4 + 1︰1 + 11 55.4 胸椎MRI正常
24 55 视物不清 1︰16 + 1︰2 + 2 29.1 颞叶海马萎缩
25 62 视力下降耳聋 1︰256 + 1︰1 + 64 46.3 侧脑室旁多发缺血脱髓鞘改变
26 61 视力下降 1︰64 + 1︰1 + 20 56.0 脑萎缩
27 37 视力下降 1︰64 + 1︰2 + 26 133.0 头MRI、头颈部CTA正常
28 37 视力下降 1︰8 + 1︰2 + 6 123.7 头MRI正常
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