（推荐医学）神经梅毒.ppt

梅毒治疗过程中的特殊反应： ①赫氏反应: 表现为急性发热性疾病伴头痛、肌痛、寒战和发冷,24 小时内可缓解;多见于早期梅毒,预防赫氏反应的方法是泼尼松每日20 ~60mg,连服3 日,在泼尼松开始治疗24 小时后开始抗梅毒治疗。 * ②普鲁卡因反应: 表现为精神异常、躁狂、Hoigne综合征,以恐惧死亡为特征,注射后立即产生幻觉或癫痫样发作。持续不到20分钟;处置上先排除过敏反应,再进行安抚,必要时也可进行行为控制,如有抽搐,可直肠/ 静脉/ 肌内给予5-10mg 的地西泮(Diazepam) * ③过敏性休克: 立即肾上腺素1:1000 肌注0.5ml，随后肌注/静注抗组胺药(如氯苯那敏10mg)、肌注/静注氢化可的松100mg。 * 神经梅毒的治疗 所有类型的神经梅毒患者： 应每3个月进行一次检查； 每间隔6个月检查一次脑脊液。 如果6个月后症状消失，脑脊液异常逆转（细胞消失、蛋白、 γ球蛋白减少，血清学转阴），则无需进一步治疗。 第9和第12个月时应进行临床检查，并在第12个月时进行腰穿检查。 若脑脊液细胞和蛋白恢复正常，血清学弱阳性持续存在，也无需进行进一步治疗。 * A 46-year-old woman with a 15-month history of progressive dementia and personality changes was admitted to our hospital due to generalized seizures and a prolonged disturbance of consciousness. She tested positive for syphilis with a rapid plasma reagent. Fluorescent treponemal antibody absorption, measured for confirmation, was also positive.A human immunodeficiency virus test was negative.Axial fluid-attenuated inversion recovery magnetic resonance imaging (MRI) revealed bilateral frontal and right insular cortical lesions (Picture A) in addition to a mesial temporal lesion (Picture B) (1, 2). The patient received a 14-day course of penicillin G (18 million units/day) with a gradual improvement in consciousness. The seizures were successfully controlled with 800 mg/day of sodium valproate. MRI showed frontal and mesial temporal atrophy three months after treatment (Picture C and D). Hitoshi Aizawa, Harumi Yomono,Hiroshi Kurisaki. Neurosyphilis Presenting as Frontal and Mesial Temporal Encephalitis. Intern Med 2013,52: 2381-2382. * A 55-year-old Caucasian man presented to our facility with acute collapse against a background of memory difficulties over the previous six months. A magnetic resonance imaging scan of his brain revealed high T2 signal intensity and atrophy within th