探讨以颅神经受累为主要表现的神经梅毒患者的临床特点。

回顾性分析20例以颅神经受累为主要表现的神经梅毒患者临床症状、实验室检查、影像学特点、治疗及转归，入组患者人类免疫缺陷病毒（HIV）筛查阴性。

20例神经梅毒患者中男性13例，女性7例，平均年龄（47.85 ± 12.99）岁，病程中位数为9.5（2.5，33）个月。17例（85%）患者急性起病，临床表现因受累颅神经不同而异。单组颅神经受累（17例，85%）较2组颅神经受累（3例，15%）患者更多见，未发现3组及以上颅神经受累者。单组颅神经受累者中，颅神经受累频率依次为视神经[5例（25%）]、听神经[5例（25%）]、外展神经[4例（20%）]、动眼神经[2例（10%]）和三叉神经[1例（5%）]。2组颅神经受累者中动眼神经合并三叉神经受累者2例（10%）、视神经合并听神经受累1例（5%）。入组患者血清梅毒螺旋体明胶颗粒凝集试验（TPPA）和甲苯胺红不加热试验（TRUST）均阳性，18例行脑脊液常规及生化检验者中脑脊液白细胞升高15例（83.33%），较蛋白升高[9例（50%）]更为常见，脑脊液中白细胞以单核细胞为主。2例患者头颅核磁共振成像（MRI）可见责任病灶，5例患者头颅MRI正常而五官MRI可见与疾病相关的异常信号。16例患者行诱发电位检查，其中8例（50%）患者诱发电位异常。20例患者中，18例给予青霉素、1例给予头孢曲松、1例给予多西环素治疗后，11例（55%）患者症状好转。

以颅神经受累为主要表现的神经梅毒患者临床表现因受累颅神经不同而异，其诊断应结合病史、辅助检查综合分析；早期诊断、规范治疗可改善患者预后。

To analyze the clinical characteristics of neurosyphilis with cranial nerve involved as the main manifestation.

The clinical manifestation, laboratory findings, neuroimages features, treatment and curative effects of 20 neurosyphilis patients with anti-HIV negative were analyzed, retrospectively. The cranial nerves were impaired as the main performance in all the subjects.

Among the 20 cases, there were 13 males and 7 femals; the average age was (47.85 ± 12.99) years old; the median course was 9.5 (2.5, 33) months. Seventeen patients (85%) had acute onset, and their clinical manifestations varied with the involvement of cranial nerves. There was 17 cases (85%) with single cranial nerve damaged, 3 cases (15%) with two cranial nerves damaged, but no case with 3 or more cranial nerve damaged. Among the patients with single cranial nerve damaged, the frequency of the cranial nerve involved ranked optic nerve (5 cases, 25%), auditory nerve (5 cases, 25%), abducent nerve (4 cases, 20%), oculomotor nerve (2 cases, 10%) and trigeminal nerve (1 cases, 5%). The serum treponema pallidum particle assay (TPPA) and toluidine red unheated serum test (TRUST) were positive in all 20 patients. Routine and biochemical detection of cerebrospinal fluid were performed in 18 patients, among whom 15 (83.33%) cases had increased leukocyte count and 9 (83.33%) had elevated protein level; the white blood cells in cerebrospinal fluid were mainly monocytes. The responsible lesions were found by cranial magnetic resonance imaging (MRI) of 2 patients cranial MRI; of 5 patients were normal, however, abnormal signals associated with disease were found in their facial MRI. Sixteen patients underwent evoked potential examination, 8 cases (50%) of whom had abnormal evoked potential. Among the 20 patients, 18 cases were treated with penicillin, 1 case was treated with ceftriaxone, and 1 case was treated with doxycycline. The symptoms of 11 cases (55%) improved.

The clinical manifestations of neurosyphilis patients with cranial nerve impaired as the main manifestation were associated with involved cranial nerves. The diagnosis of this kind of neurosyphilis should focus on the comprehensive analysis, and combine the medical history and auxiliary examination. Early diagnosis and standard therapy could improve the prognosis.