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目的分析3例被误诊为急性脑梗死接受溶栓治疗的神经梅毒患者的临床资料,提高对神经梅毒的诊断准确率,降低基层医院溶栓误治率。方法回顾性总结收治的3例以急性脑梗死起病并给以rt-PA静脉溶栓治疗神经梅毒患者的临床症状、实验室检查、脑电图及影像学检查结果、诊治过程及预后等资料,采用NIHSS评分进行神经功能评估,m RS评分进行预后评估。结合文献分析以急性脑梗死起病的神经梅毒的临床特征。结果3例以急性脑梗死起病的男性患者,接受rt-PA静脉溶栓治疗,神经功能缺损症状恶化,以往无脑血管病危险因素,影像学检查提示脑缺血和脑萎缩,血及脑脊液梅毒螺旋体明胶凝集试验和甲苯胺红不加热血清学试验阳性明确神经梅毒诊断。早期、大剂量、足疗程青霉素G治疗预后良好,NIHSS及m RS评分降低。结论以急性脑梗死起病的神经梅毒患者,静脉溶栓治疗效果差,尽早进行梅毒血清学和脑脊液检查,降低溶栓误治率,大剂量青霉素G治疗有效。
Objective To analyze the clinical data of 3 patients with neurosyphilis who were misdiagnosed as thrombolytic therapy for acute cerebral infarction and to improve the diagnostic accuracy rate of neurosyphilis and reduce the misdiagnosis rate of thrombolysis in primary hospital. Methods The clinical symptoms, laboratory tests, EEG and imaging findings, diagnosis and treatment and prognosis of 3 patients with acute cerebral infarction who were treated with rt-PA thrombolysis were retrospectively reviewed. NIHSS score was used to evaluate neurological function and mRS score was used to evaluate the prognosis. Combined with literature analysis of acute cerebral infarction neurosyphilis clinical features. Results Three male patients with acute cerebral infarction who underwent intravenous thrombolysis with rt-PA showed worsening symptoms of neurological deficits. In the past, there were no risk factors for cerebrovascular disease. Imaging examination revealed cerebral ischemia and brain atrophy, blood and cerebrospinal fluid Treponema pallidum gelatin agglutination test and toluidine red unheated serological test positive definite neurosyphilis diagnosis. Early, high-dose, full-course penicillin G treatment of good prognosis, NIHSS and m RS score decreased. Conclusions Patients with neurosyphilis who have onset of acute cerebral infarction have poor effect of intravenous thrombolysis. As soon as possible, syphilis serology and cerebrospinal fluid examination should be performed to reduce the misdiagnosis rate of thrombolysis and high-dose penicillin G treatment.