CAJ | 학술논문

目的：通过分析以帕金森综合征为主要临床表现的神经梅毒(neurosyphilis)患者的临床表现、实验室检查、脑电图和颅脑MRI的结果，提高神经梅毒诊断准确率。方法回顾性分析海南省人民医院神经内科于2010年07月至2014年12月收治的8例以帕金森综合征为主要表现的神经梅毒患者的临床表现、实验室检查及脑电图和颅脑MRI结果、诊断及疗效。结果8例以帕金森综合征为主要临床表现的神经梅毒患者(男6例、女2例)均有肌强直及运动迟缓，部分患者合并有肢体震颤、姿势障碍，精神行为异常及认知障碍；8例血清梅毒螺旋体明胶凝集试验(treponema pallidum particle agglutination，TPPA)和梅毒甲苯胺红不加热血清试验(toluidine red untreated serum test，TRUST)均阳性；所有患者的脑脊液白细胞计数均增高，蛋白质定量均增高；8例脑脊液的TPPA和TRUST均为阳性；头颅MRI以基底节区脑梗死、颞叶海马萎缩及脑室扩大为主；脑电图以中-重异常为主。所有患者均经大剂量青霉素抗梅毒治疗后临床症状均好转，UPDRS评分下降；8例患者复查血清和脑脊液的TRUST滴度下降。结论神经梅毒患者的临床表现复杂多样，有时以帕金森综合征表现为主要表现。临床上遇到以帕金森综合征的患者，应综合分析实验室、脑电图及影像学等检查结果，考虑到神经梅毒的可能性。
목적：통과분석이파금삼종합정위주요림상표현적신경매독(neurosyphilis)환자적림상표현、실험실검사、뇌전도화로뇌MRI적결과，제고신경매독진단준학솔。방법회고성분석해남성인민의원신경내과우2010년07월지2014년12월수치적8례이파금삼종합정위주요표현적신경매독환자적림상표현、실험실검사급뇌전도화로뇌MRI결과、진단급료효。결과8례이파금삼종합정위주요림상표현적신경매독환자(남6례、녀2례)균유기강직급운동지완，부분환자합병유지체진전、자세장애，정신행위이상급인지장애；8례혈청매독라선체명효응집시험(treponema pallidum particle agglutination，TPPA)화매독갑분알홍불가열혈청시험(toluidine red untreated serum test，TRUST)균양성；소유환자적뇌척액백세포계수균증고，단백질정량균증고；8례뇌척액적TPPA화TRUST균위양성；두로MRI이기저절구뇌경사、섭협해마위축급뇌실확대위주；뇌전도이중-중이상위주。소유환자균경대제량청매소항매독치료후림상증상균호전，UPDRS평분하강；8례환자복사혈청화뇌척액적TRUST적도하강。결론신경매독환자적림상표현복잡다양，유시이파금삼종합정표현위주요표현。림상상우도이파금삼종합정적환자，응종합분석실험실、뇌전도급영상학등검사결과，고필도신경매독적가능성。
Objective To analyze the clinical features, laboratory findings, electroencephalography (EEG) and neuroimaging of the neurosyphilis presented with parkinsonism as the principal manifestation to improve the diagnosis of neurosyphilis. Methods Eight eurosyphilis patients were from department of neurology of Hainan provincial people’s hospital from early July 2010 to December 2014. We retrospectively analyzed the clinical manifestation, laboratory exami?nations, neuroimaging examinations, diagnosis and treatment outcomes of 8 cases neurosyphilis who presented with par?kinsonism as principal manifestation. Results Myotonia and bradykinesia were principal symptoms in these 8 cases. Limb tremor, posture disorder, abnormal mental behavior and cognitive impairment occurred in some patients. Serum treponema pallidum particle agglutination (TPPA) and toluidine red untreated serum test (TRUST)were positive in 8 cas?es. Cerebrospinal fluid (CSF) protein and cell counts were elevated in all the patients. CSF-TPPA and TRUST were posi?tive in all the patients. The MRI showed that cerebral infarction in basal ganglia, cerebral atrophy in temporal lobe and hippocampus and ventricular enlargement in all the patients. EEG showed abnormal activity in all the patients. After treatment with a large dose of penicillin, clinical symptoms were obviously improved;the titer of serum and CSF TRUST decreased;and scores of UPDRS decreased in all the patients. Conclusions There is a wide variation in the clinical man?ifestation of the neurosyphilis. When patients present with Parkinsonism, we should comprehensively analyze the laborato?ry examinations, EEG and neuroimaging to rule out the possibility of neurosyphilis.