The Analysis With Clinical Characteristics Of Neurosyphilis

Objective:To explore the clinical characteristics of neurosyphilis,analyze the reasons for missed diagnosis and misdiagnosis in order to enhance the diagnostic performance and improve the prognosis.Methods:Retrospectively analysed the clinical date of 53 cases with neurosyphilis admitted and 13 cases with neurosyphilis suspected in our hospital from March,2007 to March,2011.Results:①In the neuronsyphilis group,there were 5.66% with Asymptomatic neurosyphilis;11.32% with Meningeal syphilis;49.06% with Meningovascular syphilis, where were 28.30% with parenchmatous neurosyphilis;0% with neuro-syphilitic gumma.②The first symptom of neurosyphilis was variant, which were as follows:the partial impairment of the nerve function 33.9% (stroke performance such as weakness of limbs,sensory disturbance,dysarthria,no speech due to aphasia,etc),vertigo 28.3%,descent of cognition 26.4%,headache 15.1%,and so on,but the pupil abnormalities (Arrow - pupil) was only 3.8%.③There were 50.9% with the increase of leukocyte count, which were predominantly lympho-cytes mostly;60.4% with the increase of protein;31.4% with the increase of leukocyte count and protein;66.0% with the increase of IgG exponent levels in CSF examination.③The MRI findings were diverse in neuronsyphilis patients. The imaging findings revealed Cere stroke appearance(43.4%),with 41.5% ischemic stroke whose imaging showed multi-infarcts with various size lesions and 1.9% hemorrhagic stroke, and followed by meningitis or encephalitis 11.3%,hydrocephalus 3.8%,demyelination in white matter 3.8%,etc.⑤The abnormal rate of neuronsyphilis group and Suspected neurosyphilis group were 80.4% and 76.9%,which were higher than that of control group in EEG(P< 0.05),and most of them were the increase of background activities and the abnormalities of diffuse slow wave. The peak latency ( PL) of the P100 were 100.80±13.13ms and 99.38±11.10ms in VEP between neuronsyphilis group and Suspected neurosyphilis group, which had significant difference compared with that of the control group.BAEP and SEP presented the prolongation of the peak latency ( PL) of the V wave,the inter peak latency ( IPL) of theⅢ-V and the peak latency ( PL) of the N20 wave. There was a significant difference among neurosyphilis group and suspected neurosyphilis group and control group ( P < 0. 05) .Conclusion:①In this research,the first-clinical symptom of neuronsyphilis was short of specificity.Main show was the partial impairment of the nerve function, followed by vertigo,descent of cognition,headache, etc. It leads to a presentation like that of high blood pressure or atherosclerosis cerebral infarction,viral enceph- alitis,Adding to concealment of one's previous medical history frequently, therefore it is misdiagnosed easily in clinic. It is necessary and important to keep one's eye on neurosyphilis if there are young stroke patients without risk factors,intracranial infections,dementia without explicit reasons,etc.②There is no characteristic evidence on routine and biochemical tests of cerebrospinal fluid(CSF) and MRI imaging findings.③The clinical electrophysiologycal examination such as EEG,VEP,BAEP,SEP is of value in the assessment of neurological dysfunction, in order to provide objective basis for clinical position or subclinical damage,and is useful to diagnosis.