神经梅毒60例临床表现分析及诊治的的体会.docVIP

神经梅毒60例临床表现分析及诊治的的体会 　　【摘要】目的：观察总结神经梅毒的临床表现及诊治经过，以提高神经梅毒的诊断和治疗水平。方法：回顾性分析复旦大学附属华山医院等2011年1月至2013年12月神经内科及皮肤科病房收治的60例神经梅毒患者的临床资料。结果：60例神经梅毒患者中男39例、女21例，临床分型：无症状型神经梅毒4例，主要表现为无症状，仅脑脊液，血清梅毒反应阳性；脑膜炎型12例，主要表现为头痛、发热，视力下降，视物成双，偶有癫痫发作；脑膜血管型9例，表现为偏瘫、偏身感觉障碍、失语，伴认知能力下降等；麻痹性痴呆型28例，表现进行性记忆力、计算力和认知能力减退，精神行为异常及神志改变等，或伴癫痫发作、阿罗瞳孔；脊髓痨型7例，表现进行性行走不稳、下肢踩棉花样感、双下肢闪电样剧痛、括约肌功能障碍、阿罗瞳孔等。结论：神经梅毒的起病隐袭，壮年多见，临床表现复杂多样，神经系统各部位都可受累，早期不易识别而容易误诊误治，但青霉素或头孢曲松治疗有效。对于疑似病例应及时行血清及脑脊液检查，可获得早期诊断，对指导治疗及预后均有重要意义。 　　【关键词】神经梅毒；临床表现；脑脊液 　　【Abstract】Objectives： To observe the clinical manifestations and diagnosis of neurosyphilis， in order to improve the diagnosis and treatment level of neurosyphilis. Methods： The clinical data of 60 patients with neurosyphilis in Huashan Hospital of Fudan University from January 2011 to December 2013 were retrospectively analyzed. Results： There were 39 males and 21 females patients with neurosyphilis. As to clinical classification， there were 4 cases of asymptomatic neurosyphilis only with cerebrospinal fluid and serum syphilis positive reaction； 12 cases of meningitis， with headache， fever， decreased vision， seeing things in pairs and occasional seizures； 9 cases of meningeal vascular type， with hemiplegia and partial body feeling obstacle， aphasia， cognitive competence decline， etc； 28 cases of paralytic dementia type， with progressive memory， computation and cognitive impairment， mental abnormal behavior， mind change， etc.， or with epileptic seizures， arrow pupil； 7 cases of tabes dorsalis type， with progressive walking instability， lower limb on cotton sample， the lightning sample pain， sphincter dysfunction of lower limbs， arrow pupil， etc. Conclusion： Clinical manifestations of neurosyphilis are complex and easy to affect the nervous system. It is not easy to identify， which may lead to misdiagnosis. But penicillin or ceftriaxone head treatment is effective. For suspected cases， serum and cerebrospinal fluid examination should be done. Early diagnosis can be obtained to