中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2013年
1期
22-25
,共4页
毛晨晖%高晶%黄颜%刘智%李力波%彭斌
毛晨暉%高晶%黃顏%劉智%李力波%彭斌
모신휘%고정%황안%류지%리력파%팽빈
神经梅毒%颞叶%磁共振成像%诊断,鉴别%脑炎,单纯疱疹%边缘叶脑炎
神經梅毒%顳葉%磁共振成像%診斷,鑒彆%腦炎,單純皰疹%邊緣葉腦炎
신경매독%섭협%자공진성상%진단,감별%뇌염,단순포진%변연협뇌염
Neurosyphilis%Temporal lobe%Magnetic resonance imaging%Diagnosis,differential%Encephalitis,herpes simplex%Limbic encephalitis
目的 探讨伴颞叶内侧病变的神经梅毒患者的临床表现、影像学特征及其可能的病理机制、鉴别诊断和临床意义.方法 回顾3例伴颞叶内侧病变的神经梅毒患者的临床表现、实验室检查结果及影像学特点、鉴别诊断和治疗效果,并据此对其病理机制进行分析.结果 3例患者均为血清和脑脊液梅毒确证试验阳性且滴度增高,以高级智能减退为首发症状,亚急性或慢性隐匿起病,有急性加重或快速进展.脑脊液检查均提示淋巴细胞为主的炎性反应,蛋白增高.脑电图为与病灶相对应的局灶性区域慢波或慢活动.头颅磁共振成像提示单侧或双侧不对称的颞叶内侧受累,均为等或稍长T,、长T2信号.其临床及影像学表现需与单纯疱疹病毒性脑炎及副肿瘤性边缘叶脑炎鉴别.经正规抗梅毒治疗后临床症状和脑脊液指标明显改善.结论 临床以高级智能减退为首发症状,影像学以颞叶内侧受累为突出改变的疾病鉴别诊断需包括神经梅毒,早期诊断和治疗临床预后较好.
目的 探討伴顳葉內側病變的神經梅毒患者的臨床錶現、影像學特徵及其可能的病理機製、鑒彆診斷和臨床意義.方法 迴顧3例伴顳葉內側病變的神經梅毒患者的臨床錶現、實驗室檢查結果及影像學特點、鑒彆診斷和治療效果,併據此對其病理機製進行分析.結果 3例患者均為血清和腦脊液梅毒確證試驗暘性且滴度增高,以高級智能減退為首髮癥狀,亞急性或慢性隱匿起病,有急性加重或快速進展.腦脊液檢查均提示淋巴細胞為主的炎性反應,蛋白增高.腦電圖為與病竈相對應的跼竈性區域慢波或慢活動.頭顱磁共振成像提示單側或雙側不對稱的顳葉內側受纍,均為等或稍長T,、長T2信號.其臨床及影像學錶現需與單純皰疹病毒性腦炎及副腫瘤性邊緣葉腦炎鑒彆.經正規抗梅毒治療後臨床癥狀和腦脊液指標明顯改善.結論 臨床以高級智能減退為首髮癥狀,影像學以顳葉內側受纍為突齣改變的疾病鑒彆診斷需包括神經梅毒,早期診斷和治療臨床預後較好.
목적 탐토반섭협내측병변적신경매독환자적림상표현、영상학특정급기가능적병리궤제、감별진단화림상의의.방법 회고3례반섭협내측병변적신경매독환자적림상표현、실험실검사결과급영상학특점、감별진단화치료효과,병거차대기병리궤제진행분석.결과 3례환자균위혈청화뇌척액매독학증시험양성차적도증고,이고급지능감퇴위수발증상,아급성혹만성은닉기병,유급성가중혹쾌속진전.뇌척액검사균제시림파세포위주적염성반응,단백증고.뇌전도위여병조상대응적국조성구역만파혹만활동.두로자공진성상제시단측혹쌍측불대칭적섭협내측수루,균위등혹초장T,、장T2신호.기림상급영상학표현수여단순포진병독성뇌염급부종류성변연협뇌염감별.경정규항매독치료후림상증상화뇌척액지표명현개선.결론 림상이고급지능감퇴위수발증상,영상학이섭협내측수루위돌출개변적질병감별진단수포괄신경매독,조기진단화치료림상예후교호.
Objective To report the clinical and neuroimaging features in three cases of neurosyphilis with mesiotemporal lobe lesions; and to discuss possible pathogenesis and differential diagnosis.Methods The clinical manifestations,laboratory examinations,neuroimaging features,differential diagnosis and curative effect of 3 cases of neurosyphilis with mesiotemporal lobe lesions were analyzed retrospectively.The possible pathogenesis was discussed.Results All of 3 cases had positive and high titer index of syphilis in both serum and cerebrospinal fluid.The onset symptom was abnormal cognitive functions with acute aggravation or rapid progression.Cerebrospinal fluid analysis implied lymphocyte predominant inflammatory reaction with increased protein.Electroencephalography showed localized slow waves as to the lesions.On brain magnetic resonance imaging,unilateral or asymmetrical bilateral mesiotemporal lobe was affected with long T2 signal.Herpes simplex virus encephalitis and paraneoplastic limbic encephalitis should beconsidered in differential diagnosis.The symptoms and laboratory indexes improved significantly after anti-syphilis treatment.Conclusions Neurosyphilis should be evaluatedin a patient with onset of abnormal cognitive functions and having mesiotemporal lobe lesions on magnetic resonance imaging.Promptly diagnosis and early treatment could achieve good prognosis.
