本文選題：神經(jīng)梅毒 + 腦血管意外��； 參考：《福建醫(yī)科大學》2011年碩士論文

【摘要】：目的:探討神經(jīng)梅毒的臨床特點,分析漏診、誤診原因,提高診斷率,改善預后。 方法:回顧性分析我院從2007年3月至2011年3月確診的53例和疑似的13例神經(jīng)梅毒臨床資料。 結(jié)果:①本組中無癥狀神經(jīng)梅毒5.66%;腦脊膜梅毒11.32%;腦膜血管梅毒49.06%;實質(zhì)型神經(jīng)梅毒33.96%,其中麻痹性癡呆28.30%;未發(fā)現(xiàn)樹膠腫性神經(jīng)梅毒病例。②臨床上首發(fā)臨床癥狀多樣,表現(xiàn)為:局灶性神經(jīng)功能缺損癥狀(如肢體無力、感覺障礙、構(gòu)音障礙、失語等卒中樣表現(xiàn))33.9%、眩暈28.3%、認知功能減退26.4%、頭痛15.1%等,而瞳孔異常(阿羅-瞳孔)僅為3.8%。③CSF的異常中白細胞增加者50.9%;CSF蛋白升高者60.4%,以淋巴細胞為主;白細胞和蛋白同時升高者31.4%;IgG指數(shù)升高者66.0%。④影像學表現(xiàn)各異,卒中樣影像學表現(xiàn)43.4%(缺血性卒中樣表現(xiàn)41.5 %,以多發(fā)、大小不一的梗死灶為主,出血性卒中1.9%)、腦炎或腦膜炎11.3%、腦積水3.8%、白質(zhì)脫髓鞘性病變3.8%、腦萎縮22.6%。⑤神經(jīng)梅毒組及疑似神經(jīng)梅毒組EEG異常率分別為80.4%和76.9%,明顯高于對照組(P0.05),以背景活動增多及彌漫性慢波異常為主。VEP中神經(jīng)梅毒組與疑似神經(jīng)梅毒組P100潛伏期分別為(100.80±13.13 )ms和(99.38±11.10)ms,其與對照組相比,P100潛伏期均顯著延長(P 0.05)。BAEP、SEP表現(xiàn)為V波潛伏期( PL)、Ⅲ-V波峰間差值( IPL)及N20波潛伏期( PL)延長,與對照組比較,差異有顯著性( P 0. 05)。 結(jié)論:①本組研究中,首發(fā)臨床表現(xiàn)以局灶性神經(jīng)功能缺損癥狀多見,其次為眩暈、認知功能減退及頭痛等。與高血壓或動脈硬化性腦梗塞、病毒性腦炎等有一定相似性。因此臨床上遇到無危險因素的青年人卒中、不明原因的顱內(nèi)感染、癡呆等情況,需警惕神經(jīng)梅毒可能。②腦脊液常規(guī)、生化檢查及影像學表現(xiàn)不具特異性。③EEG、VEP、BAEP、SEP等神經(jīng)電生理檢查有利于神經(jīng)功能障礙的評估,為臨床定位或臨床下?lián)p害提供客觀依據(jù),同時也有提示診斷作用。
[Abstract]:Objective: to explore the clinical features of neurosyphilis, analyze the causes of missed diagnosis, misdiagnosis, improve the diagnosis rate and improve the prognosis. Methods: the clinical data of 53 cases of neurosyphilis and 13 cases of suspected neurosyphilis from March 2007 to March 2011 were analyzed retrospectively. Results in this group, asymptomatic neurosyphilis 5.66; meningeal syphilis 11.32; meningeal vascular syphilis 49.06; parenchymal neurosyphilis 33.96; palsy dementia 28.30; no gumulus neurosyphilis was found. The symptoms of focal neurological impairment (such as limb weakness, sensory disturbance, dysarthria, aphasia, etc.) were as follows: stroke symptoms (33.9%), dizziness (28.3%), cognitive impairment (26.4%), headache (15.1%), and so on. In the abnormal pupil (aro-pupillary), the leukocyte increased in 50.9% and the CSF protein was increased in 60.4%, mainly in lymphocytes, while in the cases with increased WBC and protein at the same time, 66.0.4 had different imaging manifestations. Stroke-like imaging findings were 43.4% (41.5% of ischemic apoplexy), with multiple infarcts of various sizes. The abnormal rates of EEG in cerebral atrophy 22.6.5 neurosyphilis group and suspected neurosyphilis group were 80.4% and 76.9%, respectively, which were significantly higher than those in control group (P 0.05). The latency of P100 in neurosyphilis group and suspected neurosyphilis group was 100.80 鹵13.13 Ms and 99.38 鹵11.10 msrespectively in diffuse slow-wave abnormality. Compared with control group, P100 latency was significantly prolonged as V wave latency (PLP, 鈪，

本文編號：1909568