论文部分内容阅读
目的 探讨以视力损害为首发症状的神经梅毒的临床特点。设计 病例系列研究。研究对象 7例以视力损 害为首发症状的神经梅毒患者。方法 回顾分析1995年至2005年我科诊治的7例以视力损害为首发症状的神经梅毒患者的 临床、神经影像及实验室资料。 主要指标 视力、视野、眼底及血清、脑脊液的梅毒确诊试验。结果 7例患者均以急性或亚急 性视力下降起病,同时伴视野改变及视乳头水肿。4例患者头颅核磁共振扫描显示视神经信号异常,双侧大脑半球、基底节多发 性缺血灶。所有患者血清和脑脊液快速血浆反应素(RPR)试验及梅毒螺旋体血凝试验(TPHA)阳性。脑脊液蛋白及白细胞轻 度增高,脑脊液髓鞘碱性蛋白(MBP)明显增高。结论 以视力损害为首发症状的神经梅毒临床中少见,且临床特异性不强。梅 毒感染史及血清和脑脊液的梅毒确诊试验有助于诊断。
Objective To investigate the clinical features of neurosyphilis with visual impairment as the first symptom. Design case series research. Seven patients with visual impairment as the first symptom of neurosyphilis patients. Methods The clinical, neuroimaging and laboratory data of 7 patients with neurosyphilis who had visual impairment as their first symptom from 1995 to 2005 were retrospectively analyzed. The main indicators of vision, vision, fundus and serum, CSF syphilis diagnosis test. Results All the 7 patients were with acute or subacute visual acuity decreased onset, accompanied by changes in visual field and papilledema. 4 patients with cranial MRI showed abnormal optic nerve signal, bilateral cerebral hemispheres, basal ganglia multiple ischemic foci. Serum and CSF Rapid Plasma Reactive (RPR) and Treponema Parasiticus Hemagglutination (TPHA) tests were positive in all patients. Cerebrospinal fluid protein and white blood cells increased slightly, cerebrospinal fluid myelin basic protein (MBP) was significantly higher. Conclusions The neurosyphilis with the symptom of visual impairment as its first symptom is rare in clinic and its clinical specificity is not strong. Syphilis infection history and serum and cerebrospinal fluid syphilis diagnosis test will help diagnose.