CAJ | 학술논문

目的探讨以情绪躁狂为首发症状的神经梅毒的临床表现及其治疗方法.方法回顾分析2009年7月至2010年6月以情绪躁狂为首发症状的神经梅毒患者的临床资料.结果 20例患者均被误诊为精神分裂症、焦虑症、脑梗死等,均以易怒、脾气暴躁、行为冲动、思维紊乱等情绪躁狂为起病时的主要症状,部分患者同时伴有记忆力、认知能力、计算能力等的明显下降.所有患者血清快速血浆反应素环状卡片试验(RPR)及梅毒螺旋体血球凝集试验(TPHA)均阳性,脑脊液性病实验室检查试验(VDRL)阳性.经驱梅及与抗精神病药物联合治疗后,症状有不同程度改善.随访治疗后满3个月的13例患者并进行脑脊液检查,10例脑脊液VDRL滴度下降,1例VDRL转阴性,2例较治疗前无改变.结论神经梅毒临床缺乏特征性.当常规抗精神病治疗疗效不佳时,应考虑神经梅毒可能,并进行梅毒血清学及脑脊液检查.
목적 탐토이정서조광위수발증상적신경매독적림상표현급기치료방법.방법 회고분석2009년7월지2010년6월이정서조광위수발증상적신경매독환자적림상자료.결과 20례환자균피오진위정신분렬증、초필증、뇌경사등,균이역노、비기폭조、행위충동、사유문란등정서조광위기병시적주요증상,부분환자동시반유기억력、인지능력、계산능력등적명현하강.소유환자혈청쾌속혈장반응소배상잡편시험(RPR)급매독라선체혈구응집시험(TPHA)균양성,뇌척액성병실험실검사시험(VDRL)양성.경구매급여항정신병약물연합치료후,증상유불동정도개선.수방치료후만3개월적13례환자병진행뇌척액검사,10례뇌척액VDRL적도하강,1례VDRL전음성,2례교치료전무개변.결론 신경매독림상결핍특정성.당상규항정신병치료료효불가시,응고필신경매독가능,병진행매독혈청학급뇌척액검사.
Objective To assess the clinical presentations and treatment of neurosyphilis with mania as the first manifestation. Methods A retrospective study was performed. Clinical data on neurosyphilis patients with mania as the first manifestation collected from July 2009 to June 2010 were analyzed. Results Twenty cases of neurosyphilis were included in this study, which were all misdiagnosed as schizophrenia, anxiety,cerebral infarction, etc. All the patients had manic symptoms at onset, such as irritability, bad temper, impulsive behavior, disturbance in thinking, and so on. Some patients also suffered from a marked decrease in memory, calculation and cognitive ability. Rapid plasma reagin (RPR) test, Treponema pallidum hemagglutination (TPHA)test and cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test were positive in all the patients. Varying degrees of symptomatic improvement was achieved after anti-syphilis and anti-psychotic treatment. CSF was retested in 13 patients 3 months after the end of treatment, and CSF VDRL titer decreased in 10 patients, remained unchanged in 2 patients, and turned negative in 1 patient. Conclusions Neurosyphilis lacks distinctive clinical characteristics. For patients with poor response to conventional antipsychotic therapy,neurosyphilis should be considered, and serology and cerebrospinal fluid tests for syphilis are warranted.