Clinical Analysis Of45Cases With Neurosyphilis

Neurosyphilis (NS) is a late manifestation of syphilis. It is a chronicdisease of the central nervous system infections, which is caused by Treponemapallidum（TP）damaging meninges and (or) the substance of the brain. Becausethe clinical manifestations are complex or diverse, and there is no gold standardfor diagnosis, NS can be easily misdiagnosed. In this study, the clinical data ofNS patients were analyzed to understand the disease correctly andcomprehensively, improve diagnosis and treatment level, and ameliorate patientprognosis.Objective: The clinical data of NS patients were analyzed to understandthe disease correctly and comprehensively, in order to improve the diagnosticyield.Methods: We collected45cases of patients with NS who were treated inFirst Hospital of Jilin University from January2009to April2014, andanalysised their symptoms, signs, laboratory tests, imaging studies, treatmentand prognosis.Results:1.The45patients consisted of35males and10females, with anaverage age of50.24±14.34years. The ration of male to female was3.5:1.13cases came from rural areas, accounting for28.89%, and32cases came from thecity, accounting for71.11%.2. Among the45cases there were5cases of themeningeal neurosyphilis,17cases of the meningovascular neurosyphilis,21cases of the paralytic dementia, and3cases of the spinal tuberculosis. Commonclinical symptoms of the meningeal neurosyphilis were headache and meningealirritation. Common clinical symptoms of the meningovascular syphilis wereparalysis, aphasia, dizziness, unconsciousness, etc. Symptoms of the paralyticdementia were memory loss, mental and behavioral abnormalities. The spinaltuberculosis might be admitted with the symptoms of ataxia, deep sensory disturbance. Cerebrospinal fluid (CSF) and serum treponema pallidum gelatinagglutination test (TPPA) and rapid plasma regain (RPR) were positive. Headcomputer tomography (CT) of Meningeal neurosyphilis had no obviousabnormalities. The meningovascular imaging always showed acute infarction ofMulti-site. We could see infarction of frontotemporal and brain atrophy inparalysis dementia. Electroencephalogram of NS often showed abnormalities infrontotemporal.Conclusion:1. Most of the neurosyphilis patients are males. The patientsof the tabes and the paresis are older than other types, suggesting that theincubation period of these two types is longer.2. Knowing clinical featuresabout each type of NS helps us to diagnosis promptly and avoid misdiagnosis:①Patients who have subacute headache and meningeal irritation were positive,no fever, and whose cerebrospinal fluid pressure, CSF protein and white bloodcell count increased, should be pay attention to the meningeal neurosyphilis.②A young person who has no risk factors for the cerebrovascular disease, suchas hypertension, diabetes, high cholesterol, has extensive involvement of thebrain and nervous system symptoms, should be pay attention to the meningealvascular neurosyphilis.③Patients who have diffuse brain atrophy and slowdevelopment of progressive dementia, especially younger one should be payattention to the possibility of the paralytic dementia.④Patients who havesymptoms of spinal cord and dorsal root injury, but without diabetes, stomachdisorders, anemia, vitamin B12deficiency and other diseases, should be payattention to the existence of the spinal tuberculosis.3. Patients who havepositive results of serum and CSF TPPA, RPR can be diagnosed withneurosyphilis, and combing with symptoms, signs, laboratory tests and imagingcharacteristics we can type and distinguish the NS.