neurosyphilis
Introduction
Introduction to neurosyphilis Neurosyphilis is a disease caused by the infection of the nervous system by Treponema pallidum (Trepone pallidum), which is divided into congenital and acquired syphilis. The disease is mainly caused by unclean sexual intercourse, and can also be infected by mucous membranes and blood contacting pathogens. Several common clinical syphilis are: 1 asymptomatic neurosyphilis; 2 meningeal neurosyphilis; 3 vascular neurosyphilis 4 spinal cord fistula; 5 paralytic dementia; 6 congenital neurosyphilis. basic knowledge The proportion of illness: 0.0005%, the infection rate of multi-sex partners is about 5%-15% Susceptible people: no special people Mode of transmission: sexual transmission Complications: hydrocephalus, cerebral infarction, brain dysfunction
Cause
Cause of neurosyphilis
(1) Causes of the disease
The syphilis pathogen in the mother of congenital syphilis is transmitted to the fetus through the placenta. The acquired syphilis patients are mainly infected by sexual behavior.
(two) pathogenesis
After entering the blood, the Treponema pallidum can enter the cerebrospinal fluid and invade the central nervous system for 1 to 3 months.
1. Asymptomatic neurosyphilis
The pathological changes in the brain are unknown. Because the patients are not easy to obtain autopsy, it is speculated that most of them mainly involve the meninges, and a few others can affect the brain and blood vessels at the same time.
2. Meningeal neurosyphilis
Pathological changes: Although the disease is meningeal inflammation, but there is often mild cortical damage, visible diffuse inflammatory reaction of the soft brain, thickening or turbidity, sometimes visible in the thickened meninges or severely infected meninges The mum-ma is similar to miliary tuberculosis, but the two can be distinguished by microscopic examination.
Microscopic examination of the fibrous tissue of the meninges, mainly lymphocyte infiltration, can also be found in a small number of plasma cells, and there may be lymphocytic infiltration around the meningeal blood vessels, limiting the inflammation of the cerebral convex surface, there may be lymphatic around the Virchow-Robin gap Plasma cell infiltration.
The meningeal inflammation at the bottom of the brain often causes damage to the cranial nerves. It can be seen that the oculomotor, the trochlear and the facial nerve exhibit interstitial inflammatory damage. The accumulation of exudate at the bottom of the brain can block the circulation of the cerebrospinal fluid and even block the middle of the fourth ventricle. The pathological changes of hydrocephalus caused by the hole or the side hole, the ependymal layer of the ventricular wall is sand-like or granular, which is caused by the proliferation of astrocytic cells under the ependymium, as seen in the thickened meninges. The gum is swollen, and it can be seen under the microscope. It contains fibroblasts, multinucleated giant cells, and plasma cells. The center can have necrotic tissue, and the reticulin from the reticular tissue can also be found. The phase identification, because the cheese-like necrotic tissue in the tuberculous nodules does not contain reticulum, if the diameter of the gum-like swelling is as large as several centimeters, it can oppress the adjacent nerve tissue, and cause clinical appearance according to its location and size. Different focal symptoms, in the damaged pia mater, sometimes visible fibrotic astrocytic proliferation in the cerebral cortex and into the subarachnoid space, meningeal and cerebral blood vessels, common endovascular inflammation and vascular inflammation , When the cause softening of the brain.
Syphilitic meningeal damage, such as limited to the spinal cord, is called syphilitic spinal arachnoiditis, and involving the dura mater is called spinal dural inflammation.
3. vascular neurosyphilis pathological changes:
Angiogenic syphilis mainly involves the middle and small arteries of the brain and spinal cord, and the syphilitic endarteritis and the softening of the brain and spinal cord tissues in the corresponding areas.
Commonly damaged arteries have branches of the anterior cerebral artery returning to the artery. This branch is mainly for the anterior and posterior part of the caudate nucleus. The adjacent caudate nucleus and the anterior part of the sac, the middle cerebral artery and its branches can also be affected. The caudate nucleus, the lower part of the forelimb of the internal capsule, the dorsal part of the posterior branch of the internal capsule, and the globus pallidus, etc., may be involved in the vertebral artery, the basilar artery and the anterior spinal artery.
The lesion can be confined to one artery or a segment of an artery. The outer membrane of the damaged artery is thickened, lymphocytes and plasma cells are infiltrated, the middle layer is thinned, and the inner muscular layer and elastic fibers are destroyed, but sometimes the elastic fibers can remain. Intact, submucosal hyperplasia thickens to narrow the vascular lumen, thrombosis in the affected artery, and is mechanized and recanalized, some arteries form occlusive endarteritis, and smaller arteries can only be internal Membrane hyperplasia, only narrowing the lumen and no inflammatory reaction called Nissl-Alzheimer arteritis, there may be inflammatory cell infiltration around the nourishing blood vessels along the large vessel wall, and the blood vessels caused by syphilitic arteritis are different, causing damage The location of the nerve tissue is different, the softening lesions vary in size, and sometimes there are most small infarcts in the brain.
The above vascular lesions can also be found in other types of neurosyphilis, such as meningeal vascular syphilis and paralytic dementia. If syphilitic arteritis invades the anterior spinal artery or posterior spinal artery, it may cause softening of one or several spinal segments. And related to the collateral circulation of the spinal cord is good or not, the softened area has a typical infarct pathological changes, aneurysms occur in a very small number of cases.
4. Spinal cord fistula
The pathological changes of the disease are selective degeneration of nerve fiber bundles, and the posterior and posterior cords of the spinal cord, the iliac crest and the lower thoracic spinal cord are mainly seen. The vertebral membrane is especially thick, opaque, and the lower part of the spinal cord. The posterior nerve root is thin and flat, the dorsal spinal cord is significantly affected, the posterior cord becomes narrow and shrunken, and the sputum is harder than normal. If the optic nerve is involved, the intracranial segment and the optic chiasm become thinner and around. The pia mater adhesions.
Microscopic examination In the early stage of the disease, the vertebral membrane firstly has inflammatory changes and thickening, mainly infiltration of lymphocytes and plasma cells, and is confined to the soft membrane of the posterior root and the posterior root sleeve, with interstitiality in the posterior root. Neuroinflammatory changes, neurofibrosis in the roots, inflammatory cell infiltration between the fibers, and sore sheath after spinal cord, especially in thin bundles, showing myelin disintegration, nerve fiber atrophy; late nerve fibers disappearing, and There is astrocyte hyperplasia, which also contains part of connective tissue proliferation, but no necrosis and inflammatory reaction, these changes are particularly easy to affect the lower thoracic and lumbosacral segments, and sometimes invade the sympathetic afferent fibers and anterior horn The cells are denatured and other conductive bundles in the spinal cord are not affected.
In patients with cranial nerves, the cranial nerve changes are the same as those in the posterior root of the spinal cord. Generally, the cranial nerves of III, IV, and VIII are easily involved. In patients with optic neuritis, the myelin sheath of the optic nerve and the optic chiasm is lost. The infiltration is mainly in the peripheral part of the body, and the arachnoid and optic nerve are closely adhered to change the optic nerve cross-arachnoiditis.
A very small number of cases involve the cervical spinal cord and its posterior root, which is called the cervical spinal cord spasm (tabes dorsalis). The pathogenesis of this disease selectively affecting the posterior root and posterior cord degeneration of the spinal cord has not been elucidated. It is generally considered to be a poisonous degeneration. Lesions, accompanied by reactive inflammatory changes, as for the relationship between the disease and immunology, are still under investigation.
5. Paralytic dementia
Pathological changes are mainly in the cerebral cortex. Gross observation shows that the meninges become turbid and thickened, which can adhere to the cerebral cortex and the skull outside it. The brain volume is reduced, the cerebral gyrus is narrowed, the sulci is widened, and there are in the sulci. More liquid, which is most prominent in the prefrontal cortex, followed by the sacral leaf, the brain section may be enlarged on both sides of the ventricle, and the ventricular system wall often has a granular reaction on the ependymal wall. Caused.
Microscopic examination: especially in the frontal lobes and temporal lobes, there are inflammatory cell infiltration around the perivascular and meningeal vessels along the Virchow-Robin gap, mainly lymphocytes, plasma cells and phagocytic cells. The degree of inflammatory changes depends on the disease. The period and the degree of infection vary. In the blood vessels of the cortex, the outer membrane is infiltrated by lymphocytes and plasma cells, and the intima has fibroblast proliferation. Sometimes, Treponema pallidum can be found, and the neuronal cells in the cerebral cortex are diffusely degenerated. Loss, and reactive astrocytes, especially microglia, can form glial nodules in astrocyte hyperplasia, and iron deposits around small blood vessels in the brain.
In the treated cases, there are some effects on the microscopic findings, the inflammatory reaction is reduced, and even the inflammatory changes are not found, the meninges are not hyperplasia, only the nerve cells in the cerebral cortex and reactive gliosis can be seen. .
6. Congenital neurosyphilis
More stillbirth, early pregnancy can cause hydrocephalus and brain malformation and difficult to survive, there may be meningeal vascular infection in early postnatal period, chronic development of adolescents may be paralyzed dementia and spinal cord lesions, pathological changes and adults The people are basically the same.
Prevention
Neurosyphilis prevention
Since the liberation of our country, the government has banned prostitution and conducted census and prevention in some areas. By the end of the 1950s, the disease had been basically eliminated. In some countries in Europe and America, it was also due to early diagnosis and treatment and the application of penicillin and other drugs. The incidence of neurosyphilis has decreased significantly, especially the main syphilis has decreased significantly, but in the past 10 years, new syphilis patients in China, especially meningeal and vascular syphilis patients have increased, and some are accompanied by AIDS, which must be vigorously Promote medical health knowledge, strengthen cultural quality education, and make people understand the harmfulness of sexually transmitted diseases, even if they are controlled from certain systems, in order to prevent and control the occurrence of this disease from the source.
1. Early syphilis emphasizes early treatment, regular treatment, try to fight with penicillin.
2. Patients with syphilis are fully followed up after treatment. If the titer of the non-helical serum test does not decrease, or less than 2 gradients within six months, especially those treated with non-penicillin preparations, cerebrospinal fluid examination is required.
3. Patients with a history of syphilis infection, hearing, cranial nerve, meninges and visual impairment, should consider the diagnosis of neurosyphilis.
4. The spirochete serum test is positive, and there are persistent unexplained mental or neuropathy, which needs to be examined for neurosyphilis or appropriate treatment.
Complication
Neurosyphilis complications Complications hydrocephalus cerebral infarction
Treponema pallidum can invade the skin, mucous membranes, heart and other various tissues and organs, and can have a variety of clinical manifestations, which are not repeated here.
Syphilitic heart disease often occurs 10 to 20 years after suffering from syphilis, mainly invading the aorta, initially showing aortic inflammation, then aortic enlargement, aortic valve damage and aortic regurgitation; can also lead to coronary ostia Narrowing, there is no clinical symptoms in the early stage of the clinic, and there may be cardiac dysfunction, angina pectoris, cough, and hoarseness in the advanced stage.
If it affects the skull base meningeal, it can cause traffic hydrocephalus, increased intracranial pressure, and multiple cranial nerve palsy.
Syphilis infection of chronic meningeal blood vessels causes cerebral infarction and brain tissue death.
Late brain atrophy, ventricular enlargement.
Symptom
Symptoms of neurosyphilis Common symptoms Syphilis infection Genitour urinary tract crisis Sensory disturbance Powerless sensory ataxia Gay instability Single nausea tremor dementia
Asymptomatic neurosyphilis
Asymptomatic neurosyphilis is a patient with a clear primary syphilis infection or a serological syphilis test, and an abnormal change in CSF, but no clinical signs and symptoms.
The patients in this disease occur within 1 to 2 years after the initial infection, accounting for about 10% of the patients with serodiabosis. In the third year after infection, the incidence rate gradually decreases. This is because some patients turn into symptoms. Sexual neurosyphilis; another part of patients with CSF natural or treated to become normal, such patients are positive for venereal disease research laboratory test (VDRL), CSF examination of leukocytosis, mainly lymphocytes It is mild, moderately increased, protein content is increased, CSF-VDRL is about 80% positive, and the specific test for syphilis diagnosis, such as fluorescent treponemal antibody absorption test (FTA-ABS), can also be positive. reaction.
2. Meningeal neurosyphilis
It is mainly caused by syphilis spirochete, which is more common in 1-2 years after initial infection. After 5 years of infection, if it is not treated or inadequately treated, it may turn into primary syphilis such as paralytic dementia or spinal cord paralysis. .
Easy to see in Qing, middle-aged male, acute or sub-acute onset, may have headache, nausea, vomiting, pain in the neck, hard neck, fever, but also no fever, Kernig sign may be positive, severe intracranial pressure rise There may be fundus edema, meningitis at the top of the brain can induce seizures or mental disorders, cranial base meningitis often causes eye movements, block, trigeminal, spreading and facial nerve spasm, of which the above sag is particularly common, and a few patients have focal neurological signs Such as hemiparesis or sputum, suggesting that there is syphilitic arteritis in the adjacent brain tissue of meningeal inflammation, and the skin mucosa of some meningeal syphilis patients often have damage such as plaque papules, scaly rash, blisters and bullae.
3. Vascular neurosyphilis
Vascular neurosyphilis, which occurs 5 to 30 years after the initial infection with syphilis, but can also be seen within a few months after infection. The interval between the onset of young patients is shorter than that of the middle-aged, and often One of the main causes of stroke in young people is that men are more common in men than women, and there are statistical data on vascular neurosyphilis accounting for 3-15% of patients with syphilis.
More common in young, middle-aged men, first persistent headache or personality disorder, a few weeks after focal signs, and progressive aggravation, focal symptoms of different vascular occlusion syndrome depending on the affected different blood vessels If the middle cerebral artery is involved, there will be contralateral hemiplegia and partial sensation of the lesion, ipsilateral hemianopia; the main side lesion may have aphasia and other cortical dysfunction, if the lesion is the anterior cerebral artery, the lesion is contralateral hemiplegia and sensory disturbance, but Lower extremities are heavier than upper limbs, and often accompanied by urinary incontinence and mental disorders, such as euphoria, apathy and confusion, spinal cord vascular involvement, often root pain or numbness at the beginning of the disease, suggesting the upper boundary of spinal cord lesions, neck or thoracic The spinal cord is easily affected, and the symptoms of acute transverse myelopathy occur. The symptoms develop to a peak in a few hours to several days. The patient's trunk often has a sensory loss plane, paraplegia or quadriplegia, pathological reflex positive, and defecation or incontinence. .
4. Spinal cord fistula
The spinal cord spasm (tabes dorsalis) is a late-onset neurogenic syphilis with a long incubation period, which occurs 8 to 12 years after the initial infection with syphilis, and can be as short as 3 years and as long as 20 years. The age of onset is more common in 35~ At the age of 50, the male case is 4 times that of the female. The lesion selectively invades the posterior root and posterior cord of the spinal cord and causes degeneration. In the era of the lack of effective treatment for syphilis, this disease accounts for about 1/4 of the neurosyphilis, accounting for the initial infection. About 10% of patients with syphilis and inadequate treatment.
Most cases have a slow onset, a few are relatively sharp, and the general sensory disturbance occurs earlier, followed by ataxia, nutritional disorders, incontinence and impotence.
(1) Sensory disorder: Pain is the earliest symptom of spinal cord hernia. The pain is characterized by short-term pain. It lasts for a few seconds, is not fixed to other places, and is fixed in one part, mostly in the lower limbs, or in the chest. Abdominal, from a little pain, and quickly transferred to another, can also be continuous pain, it is called "lightning pain", its pain such as burning, knife cutting, electric shock, drilling, tearing, wet weather or The cold can be induced, and gradually progresses with the disease. The strange feeling is gradually increased, and it is mostly located in the trunk and lower limbs, such as ants walking feeling, wool touch feeling, acupuncture feeling, the trunk often has a band-like feeling, and the skin is warm and painful. Tactile sensation, sometimes double feeling, delayed feeling, mental dual feeling, etc., later became loss of feeling, the earliest pain loss, common areas in the tip of the nose, the outside of the neck, chest and calf in front, outside the forearm, etc. The sense of vibration and position are often extremely detrimental in the lower limbs, especially at the distal end of the limb such as the toes and fingers.
(2) dyskinesia: mainly manifested as progressive sensory ataxia, is also a unique symptom of the disease, due to the position of the lower limbs and other sense of the body lost the possibility of passing through the posterior root, resulting in unstable gait, walking must rely on Visual coordination, the base of the two feet is widened, the legs are raised very high, the step is very heavy when going down to the ground, the distance between one step and one step is different, called "spinal gait gait", and because of walking, often stand tall It is described as "elegant gait", the closed eye is difficult to sign positive, muscle strength disorder, rare may have muscle atrophy due to damage to the anterior or anterior horn.
(3) Muscle tone and reflex symptoms: As the proprioceptive afferent part is damaged at the posterior root, the reflex arc is impeded, the muscle tension is significantly decreased, and the joint may be over-extended. For example, the knee joint is bent backward to cause the knee reflex. Flexion, generally manifested as excessive movement of active and active movements of the joints, reduction or disappearance of tendon reflexes in the lower extremities, especially knee reflexes, followed by tendon reflexes, and the degree of sacral reflexes on both sides is not consistent, unless the cervical spinal cord paralysis Generally, the upper limb paralysis is not damaged, and no pathological reflex can be induced.
(4) Ocular symptoms: Most of them have pupillary abnormalities, such as small pupils, irregular edges or unequal sides. About half of the patients have a typical Argyll-Robertson's pupil, that is, the pupil is reduced, and the pupil is light. Direct and indirect responses disappear, but regulation and collective reflexes still exist, involving unilateral or bilateral pupils, sometimes only as dull and not completely disappeared, and the mechanism of A-Roche pupils has not been fully understood. It is believed that the damage is located in the front of the cerebral ventricle (pretectum), that is, the intersecting and non-intersecting nerve fibers between the optic tract and the ocular nucleus. This damage position only destroys the light reflex arc without affecting the nuclear upper pathway of the collective reaction. About one-fifth of the patients have optic atrophy, which is characterized by increasing visual loss. The primary optic atrophy is more common. Occasionally, the nerves are paralyzed and the ptosis, diplopia or strabismus appear.
(5) Visceral crisis: paroxysmal visceral pain, accompanied by paroxysmal visceral dysfunction, more common in gastric crisis, early disease can appear, unbearable sharp drama in the stomach and upper abdomen Pain, accompanied by nausea and vomiting, vomit has a strong acid odor, sometimes the episode only shows vomiting. The general attack lasts from a few hours to several days. The crisis can suddenly appear and disappear on its own, and the pain is difficult to relieve. It is difficult to eat with vomiting, which can lead to dehydration and alkalosis. Visceral crisis can also be manifested in other organs, but it is rare, such as larynx and coughing in the throat crisis; diarrhea and abdominal pain in the intestinal crisis; bladder rectum The crisis is characterized by severe pain in the bladder and rectum; the urinary tract crisis is characterized by severe pain in the urethra.
(6) Nutritional disorders: also due to the disappearance of afferent nerve function to the central nervous system.
1 Charcot's joint is a neuropathic joint disease, which is more common. It is easy to invade the knees, ankles, elbows and joints of the hands and feet. It develops rapidly. First, there are exudates in the joints, cartilage hyperplasia, late cartilage destruction, joints. The surface is uneven and has new bone formation. Due to joint edema and bone atrophy and hyperplasia, various joint deformities can be produced. The formation of Xiajia joints may be excessive relaxation of muscles and ligaments around the joints, as well as normal pain and position. Disappearance is associated with excessive damage.
2 penetrating ulcer is a painless gangrenous ulcer, which is easy to see at the base of the big toe or small toe. The epidermis is thin first. After the ulceration, the ulcer is deepened day by day, sometimes the bone is exposed, and the edge is relatively intact and difficult to heal.
(7) Sphincter dysfunction: When the lesion is located in the posterior root of the phrenic nerve, the bladder disorder can occur early; the lesion is located in other parts of the later stage, sometimes the patient has a large amount of urine retention without painful feeling, which is due to the reduction of bladder tension. In addition, urinary incontinence and impotence can occur.
Because syphilis is easy to get treatment in the early stage, the typical manifestations of spinal cord spasm are difficult to find, and the new manifestations of this disease may increase such as bladder dysfunction, flaccid paraplegia of both lower extremities, and summer cauda equine puncture and other symptoms.
5. Paralytic dementia (dementia paralytica), also known as general paralysis, is a chronic meningoencephalitis caused by treponema pallidum entering the brain parenchyma. If left untreated, it lasts 2 to 3 years and dies from the whole body muscle. Paralysis, this disease is more common in 10 to 15 years after infection with syphilis, more common in early syphilis has not been thoroughly treated, and the patient's incubation period is longer, more common in 30 to 50 years old, male is 8 times female patients, due to The patient's mental symptoms are prominent, so he is often treated in a mental hospital.
The onset is extremely slow, and it is not easy to be noticed. It is only characterized by emotional instability, irritability, headache, gradual psychiatric abnormalities, changes in living habits, memory loss and finger muscle tremors. In the advanced stage, it is characterized by mental dysfunction. Powerless, finally dead.
(1) Psychiatric symptoms: The personality changes and behaviors are abnormal. For example, the original behavior is dignified and cautious, and the words are changed without words. If they are quiet or good at managing money, they will become arrogant and wasteful. Often mistaken accounts, far-end memory can still be partially retained, while recent and immediate memory damage is most significant, analysis and judgment, orientation and self-awareness decline, early frequent sexual desire, early decline, can appear language disorder and various Delusions and hallucinations, according to mental abnormalities, can be divided into the following types:
1 exaggerated large: the most common one, its exaggerated content is based on the ability to think of superhuman, the world's richest, followed by smug and happy.
2 arrogant type: excited, wild and multi-lingual, often with destructive behavior as activities increase.
3 depression type: emotional depression, pessimism, disappointment, self-blame and self-incrimination, or chattering, suspected of suffering from incurable diseases.
4 simple decline type: emotional apathy, mental decline, slow movement, intelligent retardation.
(2) Symptoms of the nervous system: the language is mixed with mental decline, the lips, tongue, eyelids and finger muscles are shaking, the writing is trembling, the size is different, the pupil size is not equal, the edges are not neat, and the typical A- often appears. Roche pupil, patients faltering, closed eyes difficult to sign more positive, sputum reflex hyperthyroidism, but late may be due to nutritional disorders and reflexes disappeared, there may be pyramidal tract signs, occasional seizures, and even epileptic seizures.
6. Congenital neurosyphilis
Congenital neurosyphilis is rare. In pregnancy, syphilis can infect the fetus through the placental circulation. The incidence of congenital neurosyphilis is related to the mother's period of syphilis, ie mother. The longer the syphilis is, the less chance that the fetus will be born. In addition, the fetus within 4 months of age is often not susceptible to infection by Treponema pallidum, so the mother with syphilis can get it in the first 4 months of pregnancy. Full treatment of plums has the potential to prevent fetal infection with syphilis.
Children with congenital neurosyphilis who have survived may have hydrocephalus and hearing loss, often accompanied by chorioretinitis, interstitial keratitis and Hutchinson teeth and saddle nose. With age, juvenile paralytic dementia gradually emerges. Or juvenile taboid dementia (juvenile taboparesis), the degree of dementia is related to the age and extent of the disease, and simple juvenile spinal cord spasm is extremely rare.
Examine
Neurosyphilis examination
Laboratory inspection
1. Asymptomatic neurosyphilis serological syphilis test was positive, and CSF examination showed abnormal changes.
2. Meningeal neurosyphilis patients with serum VDRL are positive, lumbar puncture examination CSF pressure increased, mild turbidity, moderate number of cells, about (100 ~ 300) × 106 / L, protein mildly increased, Some patients had a slight decrease in sugar content, CSF-VDRL was positive for about 90%, and FTA-ABS was positive.
3. Patients with vascular neurosyphilis have positive serum VDRL, CSF pressure is normal, white blood cells are below (100 ~ 200) × 106 / L, mainly lymphocytes, protein content is slightly increased or normal, blood and CSF FTA-ABS Both are positive.
4. Spinal cord blood and cerebrospinal fluid VDRL 70% ~ 80% of cases are positive, both blood and cerebrospinal fluid FTA-ABS reaction are positive, early patients with CSF monocytes mild or moderate increase, protein content is also rising High, the number of late cells is more than 50 × 106 / L, still lymphocytes.
5. Paralytic dementia serum VDRL test is positive, cerebrospinal fluid pressure is basically normal, the number of cells is more (10 ~ 50) × 106 / L, mainly lymphocytes, protein increased, sugar and chloride normal, cerebrospinal fluid VDRL 100% Positive, blood and cerebrospinal fluid FTA-ABS are positive.
6. Congenital neurosyphilis blood and cerebrospinal fluid syphilis test are positive, the number of cells in the cerebrospinal fluid, protein can be light, moderately increased, IgG can also increase.
Film degree exam
Imaging examination of vascular neurosyphilis: brain CT showed single or several small low-density infarcts in the brain tissue, and cerebral angiography showed diffuse irregular stenosis in the affected cerebral arteries, suggesting that the endothelium was within a certain distance. Inflammatory proliferation.
The following examinations have differential diagnosis meaning: CT, MRI examination; EEG; skull base radiography; fundus examination.
The necessary selective examinations are based on possible causes:
1. Blood routine, blood biochemistry, electrolytes.
2. Blood sugar, immune items have examinations, differential diagnosis significance.
Diagnosis
Diagnosis and diagnosis of neurosyphilis
diagnosis
1. Asymptomatic neurosyphilis The diagnosis of patients with asymptomatic neurosyphilis mainly depends on the history of illegal contact, initial infection of the lower jaw; but more importantly, it depends on serum VDRL positive and abnormal changes in CSF.
2. Meningeal neurosyphilis according to sexually transmitted diseases or have a history of early syphilis (squat), with meningitis symptoms, blood syphilis test positive and cerebrospinal fluid inflammatory changes, can be diagnosed as meningeal neurosyphilis.
3. Vascular nerve syphilis, middle-aged people with hemiplegia or paraplegia, previous history of smelting or sexual history, serum VDRL positive reaction should consider this disease.
4. The diagnosis of spinal cord sputum is mainly based on clinical features such as lightning-like pain, progressive ataxia, deep sensory loss and A-Roche pupil. It is more helpful to consider this disease, such as blood and cerebrospinal fluid syphilis test. Positive can be diagnosed at the end.
5. Paralytic dementia is based on the slow onset of middle-aged disease, gradually appearing personality disorder and intelligent defects, and even exaggerated delusions and other mental disorders, neurological examinations have A-Roche pupil, finger and eyelid tremors and other symptoms, blood and cerebrospinal fluid VDRL and FTA - ABS test is positive when it can be diagnosed.
6. Congenital neurosyphilis The diagnosis of congenital neurosyphilis mainly depends on the patient's neuropsychiatric symptoms, blood and cerebrospinal fluid syphilis test positive, if the mother has a history of syphilis should consider this disease.
Differential diagnosis
First, syphilitic meningitis should be differentiated from the following diseases
1. Tuberculous meningitis: tuberculous meningitis has a history of tuberculosis, or fever, weight loss, night sweats and severe poisoning symptoms, cerebrospinal fluid glucose content is significantly reduced, syphilis serological test is negative.
2. Intracranial space-occupying lesions: In addition to increased intracranial pressure, there are often focal symptoms, cerebrospinal fluid syphilis response test is negative, imaging examination can show a certain brain tissue compression, displacement signs.
3. Congenital aneurysm or arteriovenous malformation: this disease often has headache, coma, history of convulsions and single-acting nerve palsy, or nystagmus of the eye movement, but also hemiparesis and meningeal irritation, skull, eyelids and skull base sometimes Vascular murmurs can be heard, and cerebral angiography or digital subtraction can determine the size and location of vascular lesions.
Second, cerebral vascular syphilis should be differentiated from cerebrovascular disease and need to be differentiated from ischemic cerebrovascular disease. The incidence of cerebral thrombosis is more than 50 years old. There is a history of hypertension arteriosclerosis, physical examination has hypertension, and fundus arteriosclerosis , and blood lipids, increased blood viscosity and other changes, cerebral embolism patients blood and cerebrospinal fluid syphilis examination are negative.
Third, the spinal cord should be differentiated from the following diseases
1. Arthritis, neuralgia, and nerve root pain: It is not difficult to distinguish by detailed medical history inquiry combined with physical examination.
2. Multiple peripheral neuritis: There is no lightning-like pain in this disease, the sensory disorder is terminal type, and there is limb paralysis, blood syphilis reaction is negative, cerebrospinal fluid is normal.
3. Spinal cord hereditary ataxia: more common in childhood, family history, normal cerebrospinal fluid, in addition to spinal cord and cerebellar damage, there are pyramidal tract signs, with somatic abnormalities such as arched feet, blood syphilis reaction is negative.
Fourth, paralytic dementia should be differentiated from dementia caused by brain organic disorders, the latter has no cerebrospinal fluid abnormalities, and the syphilis response test is negative.
