误诊为脑炎的神经系统梅毒5例报道及文献回顾

摘要

目的:分析首诊时被误诊为“脑炎”的神经系统梅毒的临床特征,探讨神经梅毒的发病特点和误诊原因.方法:回顾性分析5例被误诊为脑炎的神经梅毒患者的临床资料、实验室检验以及影像学资料,并结合文献回顾.结果:5例患者中有男性3例,女性2例;年龄35 ～ 78岁;均未合并HIV感染;其中4例在就诊时否认梅毒感染病史.首发症状为精神行为异常或认知功能障碍,脑脊液检查可发现蛋白量和(或)白细胞数升高,头颅磁共振主要提示颞叶病变,可伴有脑萎缩和脑积水.血清和脑脊液梅毒检测阳性.经规范治疗后,3例反应较好,2例预后不佳.结论:神经梅毒的临床症状复杂多样,脑脊液及影像学特征不典型,早期易误诊,尽早行血清和脑脊液梅毒检测有助于明确诊断.%Objective:To analysis the clinical characteristics of patients with neurosyphilis misdiagnosed as encephalitis and investigate the reasons for misdiagnosis.Methods:The clinical data,laboratory examination,imaging characteristics of five cases were retrospectively analyzed.Related literatures were reviewed to summarize the clinical features of neurosyphilis.Results:Three men and two women were recruited,ageing 35 ～ 78 years old,without HIV infection.Four cases denied the history of syphilis infection.The main symptoms were mental behavior disorder and cognitive dysfunction.CSF revealed increased number of cells and (or) proteins.Cranial MRI studies revealed the lesion in temporal lobe,accompany brain atrophy and hydrocephalus.The serum and cerebrospinal fluid examination of syphilis were positive.After standard treatment of penicillin and ceftriaxone,three cases received good recovery,two cases had poor prognosis.Conclusion:The clinical symptoms of neurosyphilis are complex and varied.It is easily to be misdiagnosed at early stage for lacking typical cerebrospinal fluid and MRI imaging outcome.The data of serum and cerebrospinal fluid of syphilis are helpful for diagnose.