Clinical Analysis Of 22 Cases Of Neurosyphilis

Objective To summarize the epidemiology material,clinical manifestations,laboratory tests and radiographic features of neurosyphilis patients in Ningxia region,to raise awareness and understanding about neurosyphilis clinically,strive to early diagnose and treat,decrease missed diagnosis and misdiagnosis.Methods Retrospective analysis was applied on the clinical data of 22 patients confirmed with neurosyphilis in General Hospital of Ningxia Medical University and affiliated Cardio-Cerebrovascular Disease Hospital from 2003 to 2016,to re-judge the case data according to the neurosyphilis diagnostic criteria which is proposed by China syphilis clinic guide in 2014.Results 1.In this group,19 patients were male,3 patients were female,most were middle-aged(41-65 years old)people,the cases has risen obviously since 2009 years.2.One patient admitted that he had visited prostitutes history,one patient had HIV infection and another patient was both have.3.Among the 22 patients,clinical manifestations mostly were general paresis(31.8%),and the other were meningovascular syphilis(27.3%),meningeal neurosyphilis(22.7%),tabes dorsalis(9.1%)and congenital neurosyphilis(9.1%).4.All of the 22 patients completed syphilis serum tests,the syphilis specific antibody tests(TPPA or TP-CLI)and syphilis nonspecific antibody tests(RPR or TRUST)were positive.5.In CSF examinations,5 patients cerebral pressure were more than 180mmH2 O,the scale was 23.8%(5/21),CSF white cell counts of 22 patient were greater than 5/mm3,on a scale of 5 to 330/mm3,median is 37/mm3,the classification of cytology was lymphocytes,CSF-Pro of 22 patients were more than 0.5g/L,on a scale of 0.74 to 11.96g/L,median is 1.207g/L,CSF-Glu and CSF-Cl were normal or below-normal in CSF biochemical tests.6.There were 2 patients who didn’t complete CSF syphilis tests,CSF TPPA and TRUST of 1 patient were negative,other 19 patients CSF syphilis specific antibody tests(TPPA or TP-CLI)were positive and syphilis nonspecific antibody tests(RPR or TRUST)of 5 patients were positive,14 patients were negative.7.MRI scannings of the patients didn’t have specifity,such as acute cerebral infarction,encephalatrophy,ventriculomegaly,meningeal enhancement,demyelination changes and so on.8.Most of the patients showed obvious improvement in the symptoms after treatment with penicillin or ceftriaxone.Conclusion 1.The morbidity of neurosyphilis was increasing annually,it had insidious onset and its clinical manifestations were not typical,the diagnosis rates of neurosyphilis were low in first visit,they usually were misdiagnosed.2.In the clinical work,we should be alert to the possibility of neurosyphilis about some diseases like intracranial infection,cognitive dysfunction,mental illness and unexplained epilepsy,cerebral infarction(especially adult epilepsy for the first attack and young patients with cerebral infarction).Relevant inspection of syphilis should be carried if necessary to decrease missed diagnosis and misdiagnosis.3.The favourable prognosis of neurosyphilis benefits from early,adequate dosage and long course treatment of antisyphilitics.We should try to make the earlier diagnosis and treatment.