以癫痫发作为首发症状的神经梅毒患者临床特点分析

摘要

目的 总结以癫痫发作为首发症状的神经梅毒患者的临床特点.方法 回顾性分析2014年1月至2018年1月作者医院收治的8例以癫痫发作为首发症状的神经梅毒患者的临床特征及实验室检查特点,并进行文献复习.结果 8例患者均为男性,年龄36~66岁.2例患者为脑膜血管型神经梅毒,2例为脑膜型神经梅毒,4例为麻痹性痴呆.7例患者癫痫发作形式为全面性发作,1例为局灶性发作继发全面性发作.4例(4/8)患者初诊时被误诊.8例患者血及脑脊液甲苯胺红不加热血清试验(TRUST)均为阳性.7例患者脑脊液白细胞计数增高,6例患者脑脊液蛋白增高,5例患者脑脊液白细胞计数和蛋白均增高.7例患者脑MRI检查可见异常改变,包括脑萎缩、脑梗死灶及脱髓鞘改变等,1例可见左侧颞叶高信号;另1例患者脑 MRI检查结果正常.脑电图检查结果显示3例患者正常,4例异常,主要表现为慢波增多和癫痫波发放.经过青霉素治疗,8例患者癫痫发作均得到有效控制.结论 以癫痫发作为首发症状的疾病病因鉴别诊断需考虑梅毒感染的可能,早期诊断和及时进行青霉素治疗对预后非常重要.%Objective Toexploretheclinicalfeaturesofneurosyphilispatientswithepilepticseizuresas theinitialpresentingsymptom. Methods EightsymptomaticneurosyphilispatientshospitalizedfromJanuary 2014toJanuary2018 wereretrospectivelycollected. Theclinicalmanifestationsandlaboratoryinvestigations weresummarizedinpatientswithepilepticseizuresastheinitialpresentingsymptomandrelatedliteratureswere reviewed. Results Allthe8 patients were male,agingfrom 15 to 77 years old,including 2 cases of meningovascularneurosyphilis,2casesofmeningealneurosyphilisand4casesofgeneralparesis. Thetypesof epilepticseizuresincludedgeneralizedseizuresin7cases,andfocalseizuresfollowedbygeneralizedseizuresin1 case.4 patientshad been misdiagnosed. 8 patientshad positivesyphilistoluidinered untreatedserum test (TRUST)intheserumandCSF.7patientshadCSFpleocytosis(6-24/μL)and6patientsdemonstratedelevated proteinlevels (465-1309 mg/L).5patientsexhibitedbothpleocytosisandelevatedproteinlevels. Abnormal findingsin cranial MRI werefound in 7 cases (7/8),including brain atrophy,cerebralinfarction and demyelination. Electroencephalogram wasabnormalin4patients(4/7)andrevealed:epileptiformdischargesin 1case,andslowingofbackgroundactivityin3cases. Epilepticseizureswereeffectivelycontrolledin8patients afterpenicillintherapy. Conclusions Syphilisinfectionshould beconsideredinthedifferentialdiagnosisof patientswithepilepticseizuresastheinitialpresentingsymptom. Earlydiagnosisandtimelypenicillintreatment areveryimportantforagoodprognosis.