CurrentsituationofNeurosyphilis:DiagnosisandTreatment神经梅毒的诊断治疗现状Neurosyphilis:DiagnosisandTreatment神经梅毒：诊断及治疗Introduction简介:Themanifestationsofcentralnervoussystem(CNS)syphilis,readilyrecognizedbyphysicianspracting3or4decadesago梅毒在中枢神经系统的临床表现，真正引起临床医生的关注大约在30-40年前;Thisconditionsareunfamiliartomanyphysicianstodayasaresultoftherelativerarity由于其疾病相对并不是那麽十分常见，对于大多数医生来讲，对本病的认识并不熟悉;Therehasbeenanincreaseinrecentyearsintheincidenceofacutesyphiliticmeningitisandincreasingrecognitionofawidevarietyoflaterformsofneurosyphilis,incldingparesis,gummas,ophthalmicdisease,andotologiccomplications近几年来，由于梅毒以及相关的神经梅毒的症状不断增加，甚至一系列晚期神经梅毒的不断出现，如脊髓痨、神经树胶肿、视神经、听神经的相关并发症，使得人们增加了对神经梅毒的关注。ClassificationoftheNeurosyphilis神经梅毒的分类EarlyNeurosyphilis早期神经梅毒:1)Asymptomatic无症状型;2)Symptomatic症状型:A)Acutesyphiliticmeningitis急性梅毒性脑膜炎；B)Meningovascularsyphilis膜性血管梅毒:a)Cerebrovascularsyphilis脑膜血管梅毒;b)Meningovascularsyphilisofspinalcord脊髓膜血管梅毒PerenchymatousNeurosyphilis实质性神经梅毒:1)Generalparesis系统性麻痹;2)Tabesdorsalis脊髓痨…Gummasofthenervoussystem神经系统树胶肿:1)Cerebralgummas脑树胶肿;2)Gummaofspinalcord脊髓树胶肿Asymptomatic无症状神经梅毒PresenceofabnormalitiesintheCSF脑脊液有异常表现;Absenceofotherfindingsofneurologicdisease缺乏神经系统的临床症状;Bydefinition,therearenoclinicalmanifestationsofasymptomaticneurosyphilis.定义：脑脊液有异常表现，缺乏神经系统的临床症状的梅毒患者，定义为无症状神经梅毒。Asymptomatic无症状神经梅毒AbnormalitiesintheCSF脑脊液异常的表现:10-100WBC/mm(allofwhicharelymphocytes)白细胞（主要是淋巴细胞）;aprotein（蛋白）of50-100mg/dl;arecativenontreponemalantibodytest(VDRL)intheCSF(90%)脑脊液非梅毒螺旋体抗体实验90%以上为阳性;bloodserology(RPR)isnearlyalwayspositive.血清非梅毒螺旋体抗体实验90%以上为阳性Asymptomatic无症状神经梅毒PersistenceofCSFabnormalitiesformorethan5yearsafterinfection(calledlateasymptomaticsyphilis);梅毒螺旋体感染后脑脊液持续5年出现异常，可定义为晚期无症状神经梅毒；Thedevelopmentofneurologicdiseaseinupto87%ofpatients.该类晚期无症状神经梅毒中大约有87%可能发展为有症状神经梅毒。Symptomatic症状型神经梅毒Acutesyphiliticmeningitis急性梅毒性脑膜炎Meningovascularsyphilis:脑膜血管性梅毒Cerebrovascularsyphilis;大脑膜血管性梅毒Meningovascularsyphilisofthespinalcord.脊髓膜血管性梅毒。Symptomatic症状型神经梅毒Acutesyphiliticmeningitis:急性梅毒性脑膜炎Theincubationperiodinthemajorityofpatientswithsyphilismeningitisislessthan1years;大部分梅毒性脑膜炎患者的潜伏期在一年之内；25%ofthosepatientsmeningitisisthefirstclinicalmanifestationofsyphilis;大约有25%的梅毒性脑膜炎患者是以梅毒的首发症状出现的；Asmallpercentageofpatients(15%)stillhavea2ndrashatthetimeofthemeningitis.大约15%的患者在出现梅毒性脑膜炎的同时，仍然具有二期梅毒的皮肤损害。Acutesyphiliticmeningitis急性梅毒性脑膜炎Clinicalmanifestitations:临床表现Cranialnervepalsies(sense)in40%ofcases;大约40%的患者有颅神经麻痹（感觉障碍）Thesignsofincreasedintracranialpressure;部分患者可有颅内压增高的表现Theinvolvementofcranialnerves(3rd,6th,7th,8th);多数可以累及3、6、7、8对颅神经Sensorineuraldeafnessmayoccurinabout20%ofpatients.大约20%的患者可以出现感音神经性耳聋。Acutesyphiliticmeningitis急性梅毒性脑膜炎...
