| Objective Neurosyphilis, caused by Treponema pallidum (TP), is a sexually transmitted disease of central nervous system,may result in disability and endangers mankind's health seriously. As the incidence of syphilis keeps rising in China, the domestic cases reports of neurosyphilis are increasing year by year. The clinical manifestation, serum, cerebral spinal fluid (CSF), imaging data were retrospectively analyzed and related literatures were reviewed. That is important to improve the level of diagnosis and treatment of neurosyphilis, to effectively improve the therapeutic efficacy, to decrease the recurrence rate, and to ameliorate the patients′quality of life.Methods 12 cases who were treated as neurosyphilis in the second hospital affiliated to Suzhou University in the past 10 years was obtained, other 69 cases were collected from Chinese Biomedical Literature Database(from 1997 to 2006), Chinese Medical Current Contents(from 1997 to 2006), Qinghua Periodical Database(from 1997 to 2006) and Weipu Periodical Database(from 1997 to 2006). All the 81 patients with neurosyphilis were analyzed including the clinical manifestation, abnormality of MRI, serum and CSF, therapy response and the cause of misdiagnosis.Results①The 81 patients with total data that fulfilled our study criteria consisted of 57(70.37%) male and 24(29.63%) female with an average age of 42.14±10.84 years old (19～73 years old).②Among the 81 cases there are 8.64%(7/81) asymptomatic neurosyphilis, 13.58%(11/81) meningeal syphilis, 30.86%(25/81) meningovascular syphilis, 32.10%(26/81) parenchmatous neurosyphilis, 14.81%(12/81) neuro-syphilitic gumma.③Neurosyphilis may be admitted with the symptoms of the nervous system such as limbs numbness, hemiplegic paralysis, epilepsy, altered mental status, etc. 39 cases (48.15%) were misdiagnosed as cerebral stroke, intracranial neoplasms, meningitis, cerebral abscess and so on in first visit.④All the serum and CSF syphilology test of 81 cases conformed to diagnostic criteria. CT/MRI findings of brain revealed single or multiple asymmetrical lesions, involving frontal lobe, temporal lobe, periventricular, et al.⑤10 cases were adopted operative therapy. Postoperative histopathology revealed gliocyte hyperplasia, perivasculitis and vasculitis accompanied by inflammatory cell infiltrate, especially plasmacyte and lymphocyte. All patients were treated with penicillin or cephalosporins and the patient's condition improved in varying degrees.Conclusion Neurosyphilis has various clinical manifestations, but is short of specificity. Patients with neurosyphilis could present all kinds of clinical symptoms at beginning of the course and be divided into different clinical types accordingly, therefore it is misdiagnosed easily at the first visit. It is necessary and important to do lab detection of neurosyphilis if there are intracranial infections, dementia, myelopathy or young stroke patients without unambiguous causes. However there is no characteristic evidence on CT or MR imaging findings. More importantly, positive syphilis antibody in serum and CSF is specific for diagnosis. Standardized protocols and follow-up must be applied in the treatment of the neurosyphilis patients. Early treatment has a better therapeutic effect and penicillin is the first choice for effective treatment. |
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