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目的分析神经梅毒误诊原因,提高诊断的准确率。方法回顾性分析2001年1月-2004年2月曾经在院外误诊的l2例神经梅毒患者的临床资料及误诊原因。结果12例患者中2例脑膜血管梅毒者被误诊为动脉硬化性脑梗死,2例脑膜梅毒被误诊为结核性脑膜炎和动脉瘤,2例脊髓痨被误诊为多发性神经炎,6例全身麻痹性痴呆被误诊为阿尔茨海默病、血管性痴呆、慢性酒精中毒性脑病、急性病毒性脑炎、路易体痴呆和帕金森病合并痴呆。误诊原因主要为:临床问诊忽略了患者的冶游史以及患者和家属有意隐瞒病史;体格检查不全面和定位诊断错误;全身性神经梅毒的临床表现不典型;神经梅毒的临床表现复杂多样,临床医师对其认识不足,病因诊断时考虑不充分(误诊的最主要原因)。结论神经梅毒临床表现较为复杂,临床医师对此应有充分认识,对可疑病例应注重询问相关病史,认真进行全面体格检查及特异性的血清学、脑脊液检查,以提高对本病诊断的准确率。
Objective To analyze the causes of misdiagnosis of neurosyphilis and improve the diagnostic accuracy. Methods The clinical data and misdiagnosis reasons of 12 cases of neurosyphilis who had been misdiagnosed outside the hospital from January 2001 to February 2004 were analyzed retrospectively. Results Of the 12 patients, 2 cases of meningeal vascular syphilis were misdiagnosed as arteriosclerotic cerebral infarction, 2 cases of meningeal syphilis were misdiagnosed as tuberculous meningitis and aneurysm, 2 cases of spinal cord gall bladder were misdiagnosed as polyneuritis, 6 cases of whole body Paralytic dementia is misdiagnosed as Alzheimer’s disease, vascular dementia, chronic alcoholic encephalopathy, acute viral encephalitis, dementia with Lewy bodies and Parkinson’s disease with dementia. The causes of misdiagnosis are mainly as follows: Clinical interrogation ignores the patient’s history of metallurgy and the intention of patients and their families to conceal the medical history; Incomplete physical examination and positioning diagnostic errors; The clinical manifestations of systemic neurosyphilis are not typical; The clinical manifestation of neurosyphilis is complex and diverse; Physicians did not know enough about it and did not consider the cause of the diagnosis inadequately (the most important reason for misdiagnosis). Conclusions The clinical manifestations of neurosyphilis are complicated. Clinicians should have a full understanding of this phenomenon. Suspected cases should pay attention to the relevant medical history, carefully conduct a comprehensive physical examination and specific serological and cerebrospinal fluid tests to improve the accuracy of the diagnosis of this disease .