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目的:探讨神经梅毒患者的临床表现、诊断和治疗。方法:回顾性分析7例神经梅毒患者的临床症状、体征,磁共振特点,血清、脑脊液变化及治疗。结果:7例患者中,脑膜血管型梅毒4例,脊髓痨1例,麻痹性痴呆1例,脑膜梅毒1例。头颅MRI异常6例,脊髓MRI异常1例,但无明显特异性。治疗后脑脊液蛋白、细胞数下降,血清及脑脊液TPPA无明显下降,血清及脑脊液RPR有不同程度下降。经青霉素或头孢曲松治疗,6例有效,1例出院2个月后复发。7例均未发生吉-海反应。结论:神经梅毒临床表现多种多样,临床极易误诊,脑脊液检查是关键。
Objective: To investigate the clinical manifestations, diagnosis and treatment of neurosyphilis. Methods: Seven patients with neurosyphilis were retrospectively analyzed for clinical symptoms, signs, characteristics of magnetic resonance, changes of serum and cerebrospinal fluid and their treatment. Results: In 7 patients, 4 cases of meningovascular vascular syphilis, 1 case of spinal cord gall bladder, 1 case of paralytic dementia and 1 case of meningeal syphilis. There were 6 cases of cranial MRI abnormalities and 1 case of spinal MRI abnormalities, but no obvious specificity. Cerebrospinal fluid protein, cell number decreased, serum and cerebrospinal fluid TPPA no significant decline after treatment, serum and cerebrospinal fluid RPR decreased to varying degrees. After penicillin or ceftriaxone treatment, 6 cases were effective, 1 case of recurrence after 2 months of discharge. None of the seven cases occurred Ji-Hai reaction. Conclusion: There are many clinical manifestations of neurosyphilis. It is extremely easy to misdiagnose clinically and cerebrospinal fluid examination is the key.